Does nicotine replacement therapy affect the frequency of delirium in patients after isolated myocardial revascularization?

Abstract

Aim. Among cardiac patients, active smokers are not a rarity. Smoking causes a strong addiction and smoking cessation leads to the development of a withdrawal syndrome. Due to forced smoking cessation before surgery, nicotine abstinence may become one of the reasons for the development of delirium in the immediate postoperative period. The study was designed to assess the efficacy of nicotine replacement therapy in the prevention of delirium in smoking patients after isolated myocardial revascularization surgery. 

Methods. From January 2014 to December 2014, 968 patients underwent isolated myocardial revascularization. Four hundred and twenty-eight of the above patients with the length of smoking of more than 10 years were included in the study. Nicotine replacement therapy in the smoking patients consisted of two sequential applications of nicotine patches. The first application was put in the operating room before induction into anesthesia, the second one—after 16 hours in the intensive care unit. The control group of smoking patients, in whom nicotine replacement therapy was not implemented, was formed by the selection method according to the match index with the first group. To form the group, the following criteria were used: sex, age, body mass index, length of smoking, EuroSCORE, left ventricular ejection fraction, concomitant diseases, off-pump coronary artery bypass grafting.
Results. In the immediate postoperative period the patients of both groups had episodes of delirium and agitation. Delirium developed less frequently in the group of patients receiving nicotine replacement therapy (34.7% vs 55.1%, p = 0.05). The average time of mechanical ventilation for patients with nicotine replacement therapy (3 h 35 min) was less than that for patients without nicotine replacement therapy (4 h 10 min). At the same time the groups did not differ from each other by the duration of their stay in intensive care unit, which was only one day.
Conclusion. Since smoking is a risk factor for the development of delirium, implementation of nicotine replacement therapy in smoking patients who underwent isolated myocardial revascularization can reduce not only the frequency of delirium in the early postoperative period, but also the duration of the ventilator support and the percentage of complications associated with it.

Received 10 August 2017. Revised 13 December 2017. Accepted 25 December 2017.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Author contributions
Conception and study design: M.E. Evdokimov, A.A. Gornostaev, V.V. Bazylev
Data collection and analysis: M.E. Evdokimov, A.A. Gornostaev, A.A. Schegolkov, A.V. Bulygin, E.A. Malyarova
Statistical data analysis: A.A. Schegolkov, A.V. Bulygin
Drafting the article: I.S. Fomina, A.A. Schegolkov, A.V. Bulygin, E.A. Malyarova
Critical revision of the article: M.E. Evdokimov, A.A. Gornostaev, V.V. Bazylev
Final approval of the version to be published: V.V. Bazylev, M.E. Evdokimov, A.A. Gornostaev, I.S. Fomina, A.A. Schegolkov, A.V. Bulygin, E.A. Malyarova