TY - JOUR
T1 - Effect of perioperative benzodiazepine use on intraoperative awareness and postoperative delirium
T2 - a systematic review and meta-analysis of randomised controlled trials and observational studies
AU - Wang, Eugene
AU - Belley-Côté, Emilie P.
AU - Young, Jack
AU - He, Henry
AU - Saud, Haris
AU - D'Aragon, Frederick
AU - Um, Kevin
AU - Alhazzani, Waleed
AU - Piticaru, Joshua
AU - Hedden, Matthew
AU - Whitlock, Richard
AU - Mazer, C. David
AU - Kashani, Hessam H.
AU - Zhang, Sarah Yang
AU - Lucas, Amanda
AU - Timmerman, Nicholas
AU - Nishi, Cameron
AU - Jain, Davinder
AU - Kugler, Aaron
AU - Beaver, Chris
AU - Kloppenburg, Shelley
AU - Schulman, Sam
AU - Borges, Flavia K.
AU - Kavosh, Morvarid
AU - Wada, Chihiro
AU - Lin, Sabrina
AU - Sibilio, Serena
AU - Lauw, Mandy
AU - Benz, Alexander
AU - Szczeklik, Wojciech
AU - Mokhtari, Arastoo
AU - Jacobsohn, Eric
AU - Spence, Jessica
N1 - Funding Information:
National New Investigator Award from the Heart and Stroke Foundation of Canada to EPB-C; Clinician Scientist Award from the Canadian Anesthesia Research Foundation to JS; IARS Mentored Research Award to JS.
Publisher Copyright:
© 2022 British Journal of Anaesthesia
PY - 2023/8
Y1 - 2023/8
N2 - Background: Benzodiazepine use is associated with delirium, and guidelines recommend avoiding them in older and critically ill patients. Their perioperative use remains common because of perceived benefits. Methods: We searched CENTRAL, MEDLINE, CINAHL, PsycInfo, and Web of Science from inception to June 2021. Pairs of reviewers identified randomised controlled trials and prospective observational studies comparing perioperative use of benzodiazepines with other agents or placebo in patients undergoing surgery. Two reviewers independently abstracted data, which we combined using a random-effects model. Our primary outcomes were delirium, intraoperative awareness, and mortality. Results: We included 34 randomised controlled trials (n=4354) and nine observational studies (n=3309). Observational studies were considered separately. Perioperative benzodiazepines did not increase the risk of delirium (n=1352; risk ratio [RR] 1.43; 95% confidence interval [CI]: 0.9–2.27; I2=72%; P=0.13; very low-quality evidence). Use of benzodiazepines instead of dexmedetomidine did, however, increase the risk of delirium (five studies; n=429; RR 1.83; 95% CI: 1.24–2.72; I2=13%; P=0.002). Perioperative benzodiazepine use decreased the risk of intraoperative awareness (n=2245; RR 0.26; 95% CI: 0.12–0.58; I2=35%; P=0.001; very low-quality evidence). When considering non-events, perioperative benzodiazepine use increased the probability of not having intraoperative awareness (RR 1.07; 95% CI: 1.01–1.13; I2=98%; P=0.03; very low-quality evidence). Mortality was reported by one randomised controlled trial (n=800; RR 0.90; 95% CI: 0.20–3.1; P=0.80; very low quality). Conclusions: In this systematic review and meta-analysis, perioperative benzodiazepine use did not increase postoperative delirium and decreased intraoperative awareness. Previously observed relationships of benzodiazepine use with delirium could be explained by comparisons with dexmedetomidine.
AB - Background: Benzodiazepine use is associated with delirium, and guidelines recommend avoiding them in older and critically ill patients. Their perioperative use remains common because of perceived benefits. Methods: We searched CENTRAL, MEDLINE, CINAHL, PsycInfo, and Web of Science from inception to June 2021. Pairs of reviewers identified randomised controlled trials and prospective observational studies comparing perioperative use of benzodiazepines with other agents or placebo in patients undergoing surgery. Two reviewers independently abstracted data, which we combined using a random-effects model. Our primary outcomes were delirium, intraoperative awareness, and mortality. Results: We included 34 randomised controlled trials (n=4354) and nine observational studies (n=3309). Observational studies were considered separately. Perioperative benzodiazepines did not increase the risk of delirium (n=1352; risk ratio [RR] 1.43; 95% confidence interval [CI]: 0.9–2.27; I2=72%; P=0.13; very low-quality evidence). Use of benzodiazepines instead of dexmedetomidine did, however, increase the risk of delirium (five studies; n=429; RR 1.83; 95% CI: 1.24–2.72; I2=13%; P=0.002). Perioperative benzodiazepine use decreased the risk of intraoperative awareness (n=2245; RR 0.26; 95% CI: 0.12–0.58; I2=35%; P=0.001; very low-quality evidence). When considering non-events, perioperative benzodiazepine use increased the probability of not having intraoperative awareness (RR 1.07; 95% CI: 1.01–1.13; I2=98%; P=0.03; very low-quality evidence). Mortality was reported by one randomised controlled trial (n=800; RR 0.90; 95% CI: 0.20–3.1; P=0.80; very low quality). Conclusions: In this systematic review and meta-analysis, perioperative benzodiazepine use did not increase postoperative delirium and decreased intraoperative awareness. Previously observed relationships of benzodiazepine use with delirium could be explained by comparisons with dexmedetomidine.
UR - http://www.scopus.com/inward/record.url?scp=85146074571&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2022.12.001
DO - 10.1016/j.bja.2022.12.001
M3 - Review article
C2 - 36621439
AN - SCOPUS:85146074571
SN - 0007-0912
VL - 131
SP - 302
EP - 313
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -