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Support for ondansetron use
LETTERS TO THE EDITOR
Fig 1.
277
Transesophageal echocardiography shows atrial catheter fragment in the left atrium.
superior resolution of intracardiac structures can be obtained when compared with the transthoracic approaches. The unique ability of TEE to be performed during the surgical procedure for removal was an invaluable tool. Andrew Smith, FRCA Shane J. George, FRCP FRCA Department of Anaesthesia and Intensive Care Harefield Hospital Royal Brompton and Harefield NHS Trust Harefield, Middlesex, United Kingdom REFERENCES 1. Santini F, Gatti G, Borghetti V, et al: Routine left atrial catheterization for the postoperative management of cardiac surgical patients: Is the risk justified? Eur J Cardiothorac Surg 16:218-221, 1999 2. Yeo TC, Miller FA Jr, Oh JK, Freeman WK: Retained left atrial catheter: An unusual cardiac source of embolism identified by transoesophageal echocardiography. J Am Soc Echocardiogr 11:66-70, 1998 3. Drummond-Webb JJ, Bokesch PM, Ebied MR, et al: Branch retinal artery occlusion from a retained left atrial catheter 21 years after operation. Ann Thorac Surg 65:254-255, 1998 4. Win A, Pastore JO, Coletta D, Junda RJ: Echocardiographic detection of a retained left atrial catheter. Am Heart J 99:93-95, 1980 doi: 10.1053/jcan.2001.22023
Support for Ondansetron Use To the Editor: We read with interest the report of Bayindir et al1 of 35 patients with postcardiotomy delirium treated with the 5-HT3 receptor antagonist ondansetron. In 1995, we performed a similar pilot study2 with the same impressive results, similarly without side effects. Barbara Costall from the UK reported several animal studies, which also had good results, demonstrating that ondansetron could be successfully used on scopolamine-induced delirium and alcohol dependency. A dentist with alcoholic drinking problems was treated with ondansetron and remained sober during the 4 weeks of medication. Also, 2 nurses with nicotine dependency were
278
LETTERS TO THE EDITOR
treated for 2 weeks with ondansetron without smoking relapse. However, the manufacturer of ondansetron was uninterested in our results and thus further studies were not performed at that time. Ondansetron⬘s mode of action is very interesting and one might speculate that it may reduce the inhibition of acetylcholine release. This would increase the brain acetylcholine transmittor, thus reducing the delirium. In patients with Parkinson’s disease, treatment with traditional antipsychotic agents like haloperidol, often used to treat postcardiotomy delirium, worsen their stiffness and for them ondansetron may be the perfect treatment. For these patients, and in some others, the alternative to ondansetron would be a propofol infusion, which would increase the already high cost of ICU care. Per Nellgård, MD, PhD Dept. of Cardiothoracic Anesthesiology and Intensive Care Sahlgren⬘s University Hospital Goteborg, Sweden Bengt Nellgård, MD, PhD Dept. of Neurosurgery Anesthesiology and Intensive Care Sahlgren⬘s University Hospital Goteborg, Sweden REFERENCES 1. Bayindir O, Akpinar B, Can E, et al:The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. J Cardiothorac Vasc Anesth 14:288-292, 2000 2. Nellgård P, Nellgård B: A new treatment for postoperative delirium after cardiac surgery ? 11th World Congress of Anaesthesiologists, Sydney, 1996 (abstr) doi: 10.1053/jcan.2001.22024
Fig 1.
277
Transesophageal echocardiography shows atrial catheter fragment in the left atrium.
superior resolution of intracardiac structures can be obtained when compared with the transthoracic approaches. The unique ability of TEE to be performed during the surgical procedure for removal was an invaluable tool. Andrew Smith, FRCA Shane J. George, FRCP FRCA Department of Anaesthesia and Intensive Care Harefield Hospital Royal Brompton and Harefield NHS Trust Harefield, Middlesex, United Kingdom REFERENCES 1. Santini F, Gatti G, Borghetti V, et al: Routine left atrial catheterization for the postoperative management of cardiac surgical patients: Is the risk justified? Eur J Cardiothorac Surg 16:218-221, 1999 2. Yeo TC, Miller FA Jr, Oh JK, Freeman WK: Retained left atrial catheter: An unusual cardiac source of embolism identified by transoesophageal echocardiography. J Am Soc Echocardiogr 11:66-70, 1998 3. Drummond-Webb JJ, Bokesch PM, Ebied MR, et al: Branch retinal artery occlusion from a retained left atrial catheter 21 years after operation. Ann Thorac Surg 65:254-255, 1998 4. Win A, Pastore JO, Coletta D, Junda RJ: Echocardiographic detection of a retained left atrial catheter. Am Heart J 99:93-95, 1980 doi: 10.1053/jcan.2001.22023
Support for Ondansetron Use To the Editor: We read with interest the report of Bayindir et al1 of 35 patients with postcardiotomy delirium treated with the 5-HT3 receptor antagonist ondansetron. In 1995, we performed a similar pilot study2 with the same impressive results, similarly without side effects. Barbara Costall from the UK reported several animal studies, which also had good results, demonstrating that ondansetron could be successfully used on scopolamine-induced delirium and alcohol dependency. A dentist with alcoholic drinking problems was treated with ondansetron and remained sober during the 4 weeks of medication. Also, 2 nurses with nicotine dependency were
278
LETTERS TO THE EDITOR
treated for 2 weeks with ondansetron without smoking relapse. However, the manufacturer of ondansetron was uninterested in our results and thus further studies were not performed at that time. Ondansetron⬘s mode of action is very interesting and one might speculate that it may reduce the inhibition of acetylcholine release. This would increase the brain acetylcholine transmittor, thus reducing the delirium. In patients with Parkinson’s disease, treatment with traditional antipsychotic agents like haloperidol, often used to treat postcardiotomy delirium, worsen their stiffness and for them ondansetron may be the perfect treatment. For these patients, and in some others, the alternative to ondansetron would be a propofol infusion, which would increase the already high cost of ICU care. Per Nellgård, MD, PhD Dept. of Cardiothoracic Anesthesiology and Intensive Care Sahlgren⬘s University Hospital Goteborg, Sweden Bengt Nellgård, MD, PhD Dept. of Neurosurgery Anesthesiology and Intensive Care Sahlgren⬘s University Hospital Goteborg, Sweden REFERENCES 1. Bayindir O, Akpinar B, Can E, et al:The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. J Cardiothorac Vasc Anesth 14:288-292, 2000 2. Nellgård P, Nellgård B: A new treatment for postoperative delirium after cardiac surgery ? 11th World Congress of Anaesthesiologists, Sydney, 1996 (abstr) doi: 10.1053/jcan.2001.22024