Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Effect of Zolpidem or Promethazine Premedication on Agitation, Sedation and Cognitive Disorders before and after Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors
Mojtaba Mansoori 1
Amir Bahador Boroumand 2
1 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Lack of control of agitation and patient’s pain before and after coronary artery bypass graft surgery (CABG) can cause severe and irrecoverable complications. Till the time of our study, there was no study to compare the effects of two drugs premedication, zolpidem and promethazine, in agitation, sedation and cognitive problems before and after coronary artery bypass graft surgery; we decided to do this.Methods: The study was a double-blind clinical trial on 85 patients undergoing coronary artery bypass graft in the age-range of 40 to 70 years. The subjects were divided in two groups receiving zolpidem or promethazine. The hemodynamic status, analysis of arterial blood gas, scale of sedation and agitation (SAS) and Clock Drawing Test (CDT) were checked before coronary artery bypass graft surgery, in Intensive Care Unit (ICU) and at the time of discharge.Findings: Sedation was higher and agitation was lower in zolpidem group before coronary artery bypass graft surgery and the differences were significant (P = 0.019). The score of zolpidem group was significantly more in clock drawing test before the surgery (P = 0.043).Conclusion: According to this study, patients who received zolpidem, had more sedation and less agitation than the promethazine group and cognitive disorder was less in them.
Keywords
Zolpidem
Promethazine
Premedication
Coronary artery bypass graft surgery (CABG)
Agitation
Cognitive disorder
  1. Siribaddana S. Cardiac dysfunction in the CABG patient. Curr Opin Pharmacol 2012; 12(2): 166-71.
  2. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg 2003; 96(6): 1625-30, table.
  3. Voepel-Lewis T, Burke C, Hadden SM, Tait AR, Malviya S. Nurses' diagnoses and treatment decisions regarding care of the agitated child. J Perianesth Nurs 2005; 20(4): 239-48.
  4. Dalens BJ, Pinard AM, Letourneau DR, Albert NT, Truchon RJ. Prevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia. Anesth Analg 2006; 102(4): 1056-61.
  5. Malviya S, Voepel-Lewis T, Ramamurthi RJ, Burke C, Tait AR. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile. Paediatr Anaesth 2006; 16(5): 554-9.
  6. Gravlee GP, Davis RF, Kurusz M, Utley JR. Cardiopulmonary bypass: principles and practice. 2nd. Philadelphia, PA: Lippincott Williams and Wilkins; 2002. p. 403-31.
  7. Likosky DS, Roth RM, Saykin AJ, Eskey CJ, Ross CS, O'Connor GT. Neurologic injury associated with CABG surgery: outcomes, mechanisms, and opportunities for improvement. Heart Surg Forum 2004; 7(6): E650-E662.
  8. Uhlig T, Huppe M, Nidermaier B, Pestel G. Mood effects of zolpidem versus phenobarbital combined with promethazine in an anesthesiological setting. Neuropsychobiology 1996; 34(2): 90-7.
  9. Elwood P, Hack M, Pickering J, Hughes J, Gallacher J. Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort. J Epidemiol Community Health 2006; 60(1): 69-73.
  10. Doghramji PP. Insomnia: zolpidem extended-release for the treatment of sleep induction and sleep maintenance symptoms. MedGenMed 2007; 9(1): 11.
  11. Miranda HF, Puig MM, Prieto JC, Pinardi G. Synergism between paracetamol and nonsteroidal anti-inflammatory drugs in experimental acute pain. Pain 2006; 121(1-2): 22-8.
  12. Matthews EE. Sleep disturbances and fatigue in critically ill patients. AACN Adv Crit Care 2011; 22(3): 204-24.
  13. Hsu SM, Ko WJ, Liao WC, Huang SJ, Chen RJ, Li CY, et al. Associations of exposure to noise with physiological and psychological outcomes among post-cardiac surgery patients in ICUs. Clinics (Sao Paulo) 2010; 65(10): 985-9.
  14. Cashman JN, Power SJ, Jones RM. Assessment of a new hypnotic imidazo-pyridine (zolpidem) as oral premedication. Br J Clin Pharmacol 1987; 24(1): 85-92.
  15. Cohen SI, Duong TT. Increased arousal in a patient with anoxic brain injury after administration of zolpidem. Am J Phys Med Rehabil 2008; 87(3): 229-31.
  16. Kaplan JA. Cardiac anesthesia. 3rd ed. Philadelphia, PA: Saunders; 1993. p. 467-511, 865-904.
  17. Tashjian RZ, Banerjee R, Bradley MP, Alford W, Fadale PD. Zolpidem reduces postoperative pain, fatigue, and narcotic consumption following knee arthroscopy: a prospective randomized placebo-controlled double-blinded study. J Knee Surg 2006; 19(2): 105-11.
  18. Tompkins M, Plante M, Monchik K, Fleming B, Fadale P. The use of a non-benzodiazepine hypnotic sleep-aid (Zolpidem) in patients undergoing ACL reconstruction: a randomized controlled clinical trial. Knee Surg Sports Traumatol Arthrosc 2011; 19(5): 787-91.
  19. Daglar B, Kocoglu H, Adnan CM, Goksu S, Kazaz H, Kayiran C. Comparison of the effects of lornoxicam versus diclofenac in pain management after cardiac surgery: A single-blind, randomized, active-controlled study. Curr Ther Res Clin Exp 2005; 66(2): 107-16.
Journal of Isfahan Medical School
Volume 33, Issue 336 - Serial Number 336
March and April 2015
Pages 800-812

  • Receive Date 06 June 2015
  • Accept Date 06 April 2022