• Yunyang Han, Jie Wu, Zaisheng Qin, Weijun Fu, Bingcheng Zhao, Xue Li, Wenyan Wang, Tong Sha, Maomao Sun, Jiaxin Li, Zhenhua Zeng, and Zhongqing Chen.
• Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
• J. Pineal Res. 2020 May 1; 68 (4): e12644.

AbstractIt remains unclear whether melatonin and its analogues prevent postoperative delirium (POD). Therefore, we conducted a systematic review and meta-analysis to evaluate the effect of melatonin and its analogues on POD prevention. PubMed, Cochrane Library, Web of Science, Embase and CINAHL databases were searched. Primary outcome was the incidence of POD. Six randomized controlled trials, 2 cohort studies and 1 case-control study were included in this meta-analysis. Results showed that melatonin and its analogue ramelteon decreased the incidence of POD in the entire adult surgical population (odds ratio [OR] = 0.45, 95% confidence interval [CI] 0.24-0.84, P = .01). When administered at a higher dose (5 mg), melatonin was effective in reducing the POD incidence (OR = 0.32, 95% CI 0.20-0.52, P < .00001). Melatonin administered less than 5 elimination half-lives before the surgery significantly reduced the POD incidence (OR = 0.31, 95% CI 0.19-0.49, P < .00001). Current literature supports the effectiveness of melatonin and its analogue ramelteon in POD prevention. However, the present study was limited by the significant heterogeneity of the included studies. More studies are needed to ascertain the preventive effect of melatonin and its analogues on the incidence of delirium after cardiac and noncardiac surgeries.© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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