Cholinesterases and Anticholinergic Medications in Postoperative Pediatric Delirium
Jochen Meyburg1, Mona-Lisa Ritsert1, Chani Traube2
1Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany.
Insights
Anticholinergic drug exposure is linked to postoperative delirium in children, showing a dose-response relationship. Avoiding these drugs in the pediatric intensive care unit (PICU) may be beneficial.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Pharmacology
Background:
- Postoperative delirium is a significant concern in pediatric intensive care units (PICUs).
- Anticholinergic medications are frequently used but their impact on delirium is not fully understood.
- Cholinesterase enzyme activity and inflammation are potential contributing factors.
Purpose of the Study:
- To investigate the relationship between anticholinergic drug exposure, cholinesterase enzyme activity, and inflammation in the development of postoperative delirium in children.
- To determine if cholinesterase activity or inflammatory markers mediate the effect of anticholinergic drugs on delirium.
Main Methods:
- A prospective cohort study was conducted in a 22-bed PICU.
- Ninety-three children undergoing major elective surgery were included.
- Delirium was screened twice daily for 5 postoperative days. Acetylcholinesterase and butyrylcholinesterase activity, anticholinergic drug exposure (number and Anticholinergic Drug Scale score), and C-reactive protein were measured.
Main Results:
- Anticholinergic drug exposure and Anticholinergic Drug Scale score were significantly correlated with the development of postoperative delirium, independent of disease severity.
- A dose-response relationship was observed between anticholinergic exposure and delirium.
- Postoperative butyrylcholinesterase levels were inversely related to anticholinergic drug exposure, Anticholinergic Drug Scale score, and C-reactive protein levels.
Conclusions:
- Anticholinergic drug exposure is associated with an increased risk of postoperative delirium in children, with a clear dose-response effect.
- Given available alternatives, minimizing anticholinergic exposure in the PICU is recommended.
- Further research into the mechanisms linking anticholinergic drugs, cholinesterase activity, and inflammation in pediatric delirium is warranted.
Objectives:
To describe the relationships between anticholinergic drug exposure, cholinesterase enzyme activity, inflammation, and the development of postoperative delirium in children.
Design:
Single-center prospective cohort study.
Setting:
Twenty-two bed PICU in a tertiary-care academic medical center in Germany.
Patients:
A consecutive cohort of children admitted after major elective surgery.
Interventions:
Children were screened for delirium bid over 5 consecutive postoperative days. Acetylcholinesterase and butyrylcholinesterase plasma activity levels were measured prior to surgery and once daily during the 5 day study period. Number of anticholinergic drugs and Anticholinergic Drug Scale score were calculated for each patient.
Measurements And Main Results:
Ninety-three children (age range, 0-17 yr) were included. The number of anticholinergic drugs as well as the Anticholinergic Drug Scale score were significantly correlated with development of postoperative delirium, independently of disease severity. Baseline cholinesterase enzyme levels did not differ between patients who did and did not develop postoperative delirium. Butyrylcholinesterase levels, but not acetylcholinesterase levels, dropped by 33% postoperatively, independent of the presence of postoperative delirium. Postoperative butyrylcholinesterase levels were inversely related to number of anticholinergic drugs, Anticholinergic Drug Scale score, and C-reactive protein levels.
Conclusions:
Anticholinergic drug exposure was related to development of postoperative delirium in this cohort, with demonstration of a dose-response relationship. As there are alternative options available for many of these medications, it may be reasonable to avoid anticholinergic exposure in the PICU whenever possible.
More Related Videos
08:17A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
Published on: February 27, 2018
08:49Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
Published on: October 16, 2013
Related Concept Videos
01:30Indirect-Acting Cholinergic Agonists: Pharmacological Actions
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
01:31Direct-Acting Cholinergic Agonists: Pharmacokinetics
01:26Anticholinesterase Agents: Poisoning and Treatment
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is...
01:22Indirect-Acting Cholinergic Agonists: Pharmacokinetics
Reversible agents containing quaternary amines, such as neostigmine and edrophonium, are not easily absorbed orally because they...
01:11Direct-Acting Cholinergic Agonists: Therapeutic Uses
01:26Cholinergic Antagonists: Therapeutic Uses
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal...