Efficacy of Ondansetron in the Prevention or Treatment of Post-operative Delirium— a Systematic Review

Authors

  • Nihal Haque North York General Hospital
  • Raza M. Naqvi Markham Stouffville Hospital
  • Monidipa Dasgupta Lawson Health Institute; Western University

DOI:

https://doi.org/10.5770/cgj.22.266

Keywords:

delirium, cognitive disorders, geriatric medicine, neurotransmitters

Abstract

Background

Post-operative delirium (POD) is associated with higher rates of functional decline and death. Ondansetron is a serotonin antagonist which could represent a therapeutic or preventive option in POD.

Methods

A systematic review of MEDLINE, EMBASE, CENTRAL, and PsychINFO was performed. Three randomized controlled trials (RCTs) met inclusion criteria (intervention of ondanse-tron compared to a control group).

Results

Two RCTs examined ondansetron for the treatment of POD in patients after cardiac or post-trauma surgery in the ICU. Studies assessed either a one-time dose or doses for 3 days of ondansetron or haloperidol IV. They suggested similar reductions in average delirium scores and rates in both in-terventions, although one study suggested ondansetron to be associated with higher rates of rescue haloperidol use. One RCT examined prophylactic ondansetron versus placebo IV, for five days postoperatively, to prevent POD in orthopedic patients. There were significantly fewer delirious patients in the ondansetron group. In general, studies had major meth-odological limitations and were very heterogenous in study tools, interventions used, and populations studied.

Conclusions

Ondansetron may be an effective agent for the prevention or treatment of POD, but studies are few and of poor quality, thus making the conclusions tenuous. Further large RCTs are needed.

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Published

2019-03-04

How to Cite

1.
Haque N, Naqvi RM, Dasgupta M. Efficacy of Ondansetron in the Prevention or Treatment of Post-operative Delirium— a Systematic Review. Can Geriatr J [Internet]. 2019 Mar. 4 [cited 2022 Nov. 26];22(1):1-6. Available from: https://cgjonline.ca/index.php/cgj/article/view/266

Issue

Section

Systematic Reviews/Meta-analysis