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Canadian Journal of Anesthesia, Vol 15, 63-79, Copyright © 1968 by Canadian Anesthesiologists' Society

Intravenous Diazepam for Psychiatric Reactions following Open-Heart Surgery

ANDRÉ MCCLISH M.D., F.R.C.P.(C)1, DANIEL ANDREW M.D.2, and LÉON TETREAULT M.D., M.SC, F.C.P.C.3

1 Research Center, Laval Hospital, and Assistant Professor in the Department of Anaesthesiology, Laval University, Quebec
2 Resident in Cardiology, Institute of Cardiology, Laval Hospital, Quebec
3 Department of Pharmacology, University of Montreal, Montreal

The present study, based on a series of 79 consecutive unselected patients undergoing open-heart surgery with extracorporeal circulation at the Quebec Institute of Cardiology, was undertaken to determine the occurrence and severity of postoperative psychiatric complications, to discuss some of the factors involved in their pathogenesis, and to test the effectiveness of intravenous diazepam in their prevention and control.

The 79 patients were divided into two groups: a control group of 37 subjects and a treatment group of 42 subjects. In the treatment group only, the usual postoperative analgesic medication was completed by intravenous doses of diazepam 2.5 to 5 mg. six times a day given between the doses of narcotics. Both groups were comparable as to the age, sex, height, weight, anaesthetic risk, degree of hypothermia, bypass time, duration of anaesthesia, and type of cardiac lesion.

Our results are as follows: (a) The incidence of psychiatric complications was 35.1 per cent (13 cases) in the control group and 4.7 per cent (two cases) in the treatment group, (b) There were eight minor and five major reactions in the control group in comparison to two minor and no major disturbances in the treatment group, (c) Postoperative mechanical ventilatory support was carried out more frequently in the treatment group (92.0%) than in the control group (62.1%), yet the occurrence of psychiatric reactions was 5.1 per cent in the treatment group as compared to 56.5 per cent in the control group.

It is concluded that the postoperative use of intravenous diazepam as an adjunct to the usual analgesic medication has markedly reduced the incidence and severity of psychiatric complications after intracardiac surgery with cardiopulmonary bypass. In the treatment group, the use of intravenous diazepam has resulted in better patient behaviour, and an improved patient-nurse and patientdoctor relationship. Because of the amnesic properties of this drug, the I.C.U. is no longer described as a "torture chamber" to prospective patients.

Note:

Presented at the Annual Meeting of the Canadian Anaesthetists' Society, June 26-30, 1967. From the Research Center and the Department of Anaesthesiology, Institute of Cardiology, Laval Hospital, Quebec.






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Copyright © 1968 by the Canadian Anesthesiologists' Society.