{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:55:23Z","timestamp":1790096123125,"version":"4.0.1"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"\n Importance<\/jats:title>\n Delirium is common after cardiac surgery and associated with adverse outcomes. Intraoperative benzodiazepines may increase postoperative delirium but restricting intraoperative benzodiazepines has not yet been evaluated in a randomized trial.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether an institutional policy of restricted intraoperative benzodiazepine administration reduced the incidence of postoperative delirium.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This pragmatic, multiperiod, patient- and assessor-blinded, cluster randomized crossover trial took place at 20 North American cardiac surgical centers. All adults undergoing open cardiac surgery at participating centers during the trial period were included through a waiver of individual patient consent between November 2019 and December 2022.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Institutional policies of restrictive vs liberal intraoperative benzodiazepine administration were compared. Hospitals (clusters) were randomized to cross between the restricted and liberal benzodiazepine policies 12 to 18 times over 4-week periods.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the incidence of delirium within 72 hours of surgery as detected in routine clinical care, using either the Confusion Assessment Method\u2013Intensive Care Unit or the Intensive Care Delirium Screening Checklist. Intraoperative awareness by patient report was assessed as an adverse event.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n During the trial, 19\u202f768 patients (mean [SD] age, 65 [12] years; 14\u202f528 [73.5%] male) underwent cardiac surgery, 9827 during restricted benzodiazepine periods and 9941 during liberal benzodiazepine periods. During restricted periods, clinicians adhered to assigned policy in 8928 patients (90.9%), compared to 9268 patients (93.2%) during liberal periods. Delirium occurred in 1373 patients (14.0%) during restricted periods and 1485 (14.9%) during liberal periods (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.01;\n P<\/jats:italic>\n \u2009=\u2009.07). No patient spontaneously reported intraoperative awareness.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In intention-to-treat analyses, restricting benzodiazepines during cardiac surgery did not reduce delirium incidence but was also not associated with an increase in the incidence of patient-reported intraoperative awareness. Given that smaller effect sizes cannot be ruled out, restriction of benzodiazepines during cardiac surgery may be considered. Research is required to determine whether restricting intraoperative benzodiazepines at the patient level can reduce the incidence of postoperative delirium.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03928236<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2024.6602","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T12:40:46Z","timestamp":1738154446000},"page":"286","source":"Crossref","is-referenced-by-count":33,"title":["Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative Delirium"],"prefix":"10.1001","volume":"160","author":[{"given":"Jessica","family":"Spence","sequence":"first","affiliation":[{"name":"Population Health Research Institute, Hamilton, Ontario, Canada"},{"name":"Department of Anesthesia and Critical Care, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"World Health Research Trust, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. J.","family":"Devereaux","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"World Health Research Trust, Hamilton, Ontario, Canada"},{"name":"Department of Medicine, Cardiology, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun-Fu","family":"Lee","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9rick","family":"D\u2019Aragon","sequence":"additional","affiliation":[{"name":"Departement d\u2019anesth\u00e9siologie, Universit\u00e9 de Sherbrooke, Sherbrooke, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Avidan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Washington University at St Louis School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P.","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"World Health Research Trust, Hamilton, Ontario, Canada"},{"name":"Department of Surgery, Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. David","family":"Mazer","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Departments of Anesthesiology and Pain Medicine, Physiology, and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Rousseau-Saine","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019anesth\u00e9sie, Institut de cardiologie de Montr\u00e9al, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja Ramaswamy","family":"Rajamohan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, St Paul\u2019s Hospital, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kane O.","family":"Pryor","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rael","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care Medicine, Queen Elizabeth II Health Sciences, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Cameron","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Di Sante","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"DeBorba","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Mustard","sequence":"additional","affiliation":[{"name":"St Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne J.","family":"Couture","sequence":"additional","affiliation":[{"name":"Institut universitaire de cardiologie et de pneumologie de Qu\u00e9bec - Universit\u00e9 Laval, Qu\u00e9bec, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffael Pereira Cezar","family":"Zamper","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W. 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