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Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis
Author(s) -
Han Yunyang,
Wu Jie,
Qin Zaisheng,
Fu Weijun,
Zhao Bingcheng,
Li Xue,
Wang Wenyan,
Sha Tong,
Sun Maomao,
Li Jiaxin,
Zeng Zhenhua,
Chen Zhongqing
Publication year - 2020
Publication title -
journal of pineal research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 131
eISSN - 1600-079X
pISSN - 0742-3098
DOI - 10.1111/jpi.12644
Subject(s) - melatonin , medicine , odds ratio , meta analysis , incidence (geometry) , cochrane library , confidence interval , point of delivery , delirium , randomized controlled trial , population , anesthesia , intensive care medicine , biology , environmental health , agronomy , physics , optics
It remains unclear whether melatonin and its analogues prevent postoperative delirium (POD). Therefore, we conducted a systematic review and meta‐analysis to evaluate the effect of melatonin and its analogues on POD prevention. PubMed, Cochrane Library, Web of Science, Embase and CINAHL databases were searched. Primary outcome was the incidence of POD. Six randomized controlled trials, 2 cohort studies and 1 case‐control study were included in this meta‐analysis. Results showed that melatonin and its analogue ramelteon decreased the incidence of POD in the entire adult surgical population (odds ratio [OR] = 0.45, 95% confidence interval [CI] 0.24‐0.84, P = .01). When administered at a higher dose (5 mg), melatonin was effective in reducing the POD incidence (OR = 0.32, 95% CI 0.20‐0.52, P < .00001). Melatonin administered less than 5 elimination half‐lives before the surgery significantly reduced the POD incidence (OR = 0.31, 95% CI 0.19‐0.49, P < .00001). Current literature supports the effectiveness of melatonin and its analogue ramelteon in POD prevention. However, the present study was limited by the significant heterogeneity of the included studies. More studies are needed to ascertain the preventive effect of melatonin and its analogues on the incidence of delirium after cardiac and noncardiac surgeries.