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	Since this article does not have an abstract, we have provided the first 134 words of the full text and any section headings.

To the Editor: Delirium after cardiac surgery is a common complication.¹ The study by Dr Mitchell and colleagues² on the use of amiodarone to protect cardiac surgery patients from postoperative atrial fibrillation did not include the incidence of postoperative delirium in their patients, or data on the effect of amiodarone on this outcome.

Amiodarone may cause delirium at doses used in this study.^3-4 This is not surprising because amiodarone blocks muscarinic cholinergic receptors,⁵ and drugs with anticholinergic activity can cause delirium.⁶ Because amiodarone has anticholinergic activity, its use should be avoided in elderly patients who may already have a cholinergic deficit.⁶ Advocating the broad use of amiodarone to prevent postoperative atrial fibrillation is not warranted in the absence of data showing a lack of effect of amiodarone on postoperative delirium.

Financial Disclosures: None reported.

Madan M. Kwatra, PhD
Kwatr001@mc.duke.edu
Department of Anesthesiology
Duke University Medical Center
Durham, NC

1. Rudolph JL, Babikian VL, Birjiniuk V, et al. Atherosclerosis is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc. 2005;53:462-466. FULL TEXT | PUBMED 2. Mitchell LB, Exner DV, Wyse DG, et al. Prophylactic oral amiodarone for the prevention of arrhythmias that begin early after revascularization, valve replacement, or repair: PAPABEAR: a randomized controlled trial. JAMA. 2005;294:3093-3100. FREE FULL TEXT 3. Athwal H, Murphy G Jr, Chun S. Amiodarone-induced delirium. Am J Geriatr Psychiatry. 2003;11:696-697. FREE FULL TEXT 4. Barry JJ, Franklin K. Amiodarone-induced delirium. Am J Psychiatry. 1999;156:1119. FREE FULL TEXT 5. Cohen-Armon M, Schreiber G, Sokolovsky M. Interaction of the antiarrhythmic drug amiodarone with the muscarinic receptor in rat heart and brain. J Cardiovasc Pharmacol. 1984;6:1148-1155. ISI | PUBMED 6. Tune LE. Serum anticholinergic activity levels and delirium in the elderly. Semin Clin Neuropsychiatry. 2000;5:149-153. PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295:2247-2248.

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