Efficacy of Ramelteon for delirium after lung cancer surgery

OBJECTIVES: The aim of the study was to evaluate the feasibility of Ramelteon for the prevention of delirium after lung cancer surgery in elderly patients. METHODS: Medical records of patients over 70 years old, who underwent anatomical pulmonary resection for lung cancer at our institution from January 2013 to December 2015, were reviewed. Patients treated in 2013 and 2014 were used as a control group. Ramelteon was administered daily for 7 days after surgery. The incidence of delirium was determined based on the Intensive Care Delirium Screening Checklist (ICDSC). Scores of >= 4 and 1-3 points were used for the diagnoses of delirium and a pre-delirious state, respectively. RESULTS: There were 24 patients in the Ramelteon group and 58 patients in the control group. ICDSC scores of >= 4 points were found for no patients in the Ramelteon group and 5 (9%) in the control group, whereas 21 (88%) and 49 (85%) patients, in the respective groups, had ICDSC scores of 0 points. The average incidence of events, associated with delirium, showed a trend of being lower in the Ramelteon group (0.25 +/- 0.74 vs 1.58 +/- 4.93, P = 0.061), and all events in the Ramelteon group occurred on the day of surgery. Thus, only one day was required for complete recovery from delirium in the Ramelteon group, whereas 8 days were needed in the control group. The peak delirious state occurred after 5 days in the control group. CONCLUSIONS: Ramelteon is likely to reduce the incidence and intensity of delirium after surgery for lung cancer in elderly patients.