Statins – good for the heart, bad for the brain?

A study in the Canadian Medical Journal, accompanied by a commentary, looks at statins and postoperative delirium.

This condition (“an acute change in mental status that is worrisome to patients and families”) is a big concern for many elderly patients (and their families) having major surgery. Unfortunately we don’t yet know enough about the predisposing factors and direct causes to do very much about preventing postoperative delirium, apart from avoiding some things which are obviously bad for all patients (e.g. low blood pressure, inadequate oxygen, etc). Delirium increases the average length of a hospital stay by about a week, is associated with a variety of complications and increased costs, and may even be linked to permanent brain deficits.

This study suggests that statin drugs predispose to postoperative delirium. Is the conclusion correct? Should it change medical practice, which currently strongly favors the continuation of statins after surgery because of their protective effect on the heart?

Why hasn’t dad woken up after his heart surgery?

Sedation helps patients tolerate the uncomfortable bodily invasions of high tech intensive care. But when dad isn’t “waking up”, or just “isn’t himself”, many family members want to know whether sedatives are responsible for the prolonged problems with wakefulness, memory, and cognition seen in a significant number of patients who have received care in the Intensive Care Unit (ICU).

Benzodiazepines like lorazepam (Ativan)(cousin:Valium) are inexpensive, effective and safe sedatives for this purpose, with very little impact on organ systems other than the brain (that’s a good thing).

Dexmedetomidine is a new sedative drug marketed as the more easily pronounceable Precedex™. It is cousin to clonidine, a blood pressure medicine that’s been around for many years, which also has sedative properties. Precedex has pain-relieving properties and can cause the heart to slow and the blood pressure to drop in some patients.

Because Precedex works in a different way to the standard sedatives (it blocks alpha-adrenergic receptors) there is hope that it represents a better option for some conditions and procedures. Could it have less long term effect than other drugs on the brain?