Intravenous diazepam for psychiatric reactions following open-heart surgery

Delirium after cardiac surgery: a critical review

Numerous articles have been published investigating the incidence of and risk factors for delirium after cardiac surgery. Smith and Dimsdale reviewed the literature on postcardiotomy delirium in 1987 using a meta-analysis of 44 research studies. However, doubts about their methods and results caused the authors to re-examine the literature using these 44 references as well as computerized literature searches to gather research and review papers from medical journals. Delirium after cardiac surgery appeared to be ill-defined in most of these studies. The methods and instruments used to assess delirium proved to be very different, and the patient samples were rather heterogeneous. Therefore, in most cases, the results are not comparable. Only a small number of the studies that were examined fit the criteria for statistical meta-analysis. On the basis of our analysis, a tentative conclusion may be drawn that the incidence of postcardiotomy delirium has declined slightly and that no strong risk factors have yet been identified.

Current management of patients after cardiopulmonary bypass

The postoperative management of cardiac surgical patients is reviewed with particular reference to some of the recent advances and current controversies. It is emphasised that there has been a marked decrease in the incidence of many of the major problems associated with cardiopulmonary bypass and that, in the majority of cases, cardiac surgery is now a routine procedure associated with a very low morbidity and mortality.

A comparison of memory under three methods of anaesthesia with nitrous oxide and curare

Sixty-three volunteer patients participated in an investigation disigned to evaluate memory of the surgical experinece with three different methods of balanced nitrous oxide-curare anaesthesia. Two of the methods (Liverpool and Roosevelt protocols) used thiopentone for induction but did not utilize any neuroleptic drug, while the third (Diazepam protocol) used the tranquilizer diazepam in combination with morphine for both premedication and induction. In general, the results suggest that all three variations are successful in producing anaesthesia and that patients have no recall of the major portion of the surgical procedure. The major differences among the groups were exhibited in the post-operative periods. These findings suggest that diazepam affects the emotional quality associated with memory and thus aids the patients by reducing both the incidence of noxious psychological reactions and the possibility of severe emotional trauma. Finally, the findings also suggest the importance of using a narcotic analgesic as part of nitrous oxide-curare anaesthesia.