title: Effect of melatonin on duration of delirium in organophosphorus compound poisoning patients: A double-blind randomised placebo controlled trial.
abstract: OBJECTIVE
  Organophosphate compound poisoning (OPCP) is associated with high incidence of delirium. Melatonin has been tried in the treatment of delirium and has shown a beneficial effect in OPCP. This study was conducted to know the effect of melatonin on duration of delirium and recovery profile in OPCP patients.
  
  
  METHODS
  Double-blind randomised placebo control trial in which 56 patients of OPCP confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged >18 years and weighing between 50 and 100 kg, and Acute Physiology and Chronic Health Evaluation II score of <20 were studied. Group M (n= 26) received tablet melatonin 3 mg and Group C (n= 30) received placebo tablet at 9 PM, every night throughout the Intensive Care Unit (ICU) stay. Delirium was assessed using the Confusion Assessment Method for ICU, thrice a day. Sedation was provided with injection midazolam, fentanyl and lorazepam. Duration of mechanical ventilation, vital parameters, ICU stay, sedative and atropine requirement, were recorded.
  
  
  RESULTS
  The time taken to be delirium free was significantly lower in Group M (6 ± 2.92 days) compared to Group C (9.05 ± 2.75 days) (P= 0.001) and prevalence of delirium was significantly decreased in Group M compared to Group C from day 3 onwards. The requirement of midazolam (Group M - 2.98 ± 4.99 mg/day, Group C - 9.68 ± 9.17 mg/day,P< 0.001) and fentanyl (Group M - 94.09 ± 170.05 μg/day, Group C - 189.33 ± 156.38 μg/day,P= 0.03) decreased significantly in Group M. There was no significant difference in the average atropine consumption (P= 0.27), duration of mechanical ventilation (P= 0.26), ICU stay (P= 0.21) and the number of patients requiring mechanical ventilation (P= 0.50).
  
  
  CONCLUSIONS
  Orally given melatonin in organophosphate compound poisoning patients reduces the duration of delirium and the requirement of sedation and analgesia.
authors.affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: H N
authors.initials: HN
authors.lastname: Vijayakumar
authors.affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: K
authors.initials: K
authors.lastname: Ramya
authors.affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: Devika Rani
authors.initials: DR
authors.lastname: Duggappa
authors.affiliation: Department of Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: Km Veeranna
authors.initials: KV
authors.lastname: Gowda
authors.affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: K
authors.initials: K
authors.lastname: Sudheesh
authors.affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Nethra
authors.affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: R S
authors.initials: RS
authors.lastname: Raghavendra Rao
keywords: Delirium; melatonin; organophosphorus compound poisoning; sedation