Vitamin B1 (Thiamine) May Help Prevent Post-Surgery Confusion

observational-study PMID: 31017569

Quick Summary: A study found that giving patients a vitamin B complex, including Vitamin B1 (Thiamine), during heart surgery may lower their risk of confusion and delirium after the procedure.

Vitamin B1 and Post-Surgery Delirium: What's the Link?

This research looked at whether adding a vitamin B complex to the fluid used during heart bypass surgery could help prevent delirium (a state of confusion) after the operation. The study found that patients who received the vitamin B complex were less likely to experience delirium.

Study Details

Who was studied: 138 patients who had low levels of Vitamin B12 and were undergoing heart bypass surgery.

How long: The study looked at patients between 2013 and 2017.

What they took: One group received a vitamin B complex, including 25mg of Vitamin B1 (Thiamine), added to the fluid used during surgery. The other group did not receive the vitamin B complex.

What This Means For You

If you're having heart bypass surgery and have low Vitamin B12 levels, this research suggests that getting a Vitamin B complex, including Vitamin B1, during the procedure might lower your chances of becoming confused after surgery. However, it's important to remember:

This study focused on a specific group: People with low Vitamin B12 undergoing heart bypass surgery.

It's not a cure-all: The study showed a reduced risk, not a complete elimination of delirium.

Talk to your doctor: Always discuss any concerns about surgery and potential supplements with your healthcare provider.

Study Limitations

It's important to keep these things in mind:

Not a perfect study: This study wasn't designed to prove that Vitamin B1 directly caused the change. Other factors could have played a role.

Combination of vitamins: The study used a mix of B vitamins, so we don't know for sure if Vitamin B1 alone was responsible for the results.

Specific to surgery: The findings apply to a specific type of surgery and a specific group of people.

Key Findings

The study found that adding a vitamin B complex (including 25 mg thiamine hydrochloride) to the cardiopulmonary bypass (CPB) prime solution significantly reduced the incidence of postoperative delirium (POD) in cobalamin-deficient patients undergoing on-pump coronary artery bypass grafting (CABG). The study group had a 26% POD rate compared to 42% in the control group (P = 0.017). Delirium severity scores (measured by DRS-R-98) were also lower in the study group (15.03 ± 2.48 vs. 16.5 ± 2.9, P = 0.034). Logistic regression identified vitamin B complex supplementation as an independent protective factor against POD (OR: 0.23, 95% CI: 0.06–0.83, P = 0.025).

Study Design

This was an observational study conducted between 2013 and 2017, analyzing 138 patients with preoperative vitamin B12 deficiency (serum B12 <200 pg/mL) undergoing CABG. Participants were divided into a control group (n=69) and a study group (n=69). The study group received vitamin B complex in the CPB prime solution, while the control group did not. Delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC) and DRS-R-98.

Dosage & Administration

The vitamin B complex administered included 25 mg thiamine hydrochloride (B1), 2.734 mg riboflavin (B2), 5 mg pyridoxine (B6), 15 mcg cobalamin (B12), 50 mg niacinamide, and 17.2 mg D-panthenol. It was added to the CPB prime solution and delivered intravenously during surgery.

Results & Efficacy

POD Incidence: 18/69 (26%) in the study group vs. 29/69 (42%) in the control group (P = 0.017).
Delirium Severity: Study group had lower DRS-R-98 scores (15.03 ± 2.48 vs. 16.5 ± 2.9, P = 0.034).
Protective Effect: Vitamin B complex reduced POD risk by 77% (OR: 0.23, 95% CI: 0.06–0.83, P = 0.025).

Limitations

Observational Design: Cannot establish causality; potential for confounding variables (e.g., unmeasured nutritional deficiencies).
Selection Bias: Groups were not randomized, and baseline characteristics (e.g., age, comorbidities) may have influenced outcomes.
Combination Intervention: The B complex included multiple vitamins, making it unclear whether thiamine alone or synergistic effects drove the observed benefits.
Population Specificity: Results apply only to cobalamin-deficient CABG patients; broader applicability is uncertain.
Sample Size: Moderate cohort size (n=138) limits generalizability.

Clinical Relevance

For cobalamin-deficient patients undergoing on-pump CABG, intravenous thiamine (25 mg) as part of a B complex in CPB prime solution may reduce POD risk and severity. However, since the study used a multi-B-vitamin formulation, the specific contribution of thiamine remains unproven. These findings support further investigation into targeted B-vitamin supplementation in high-risk surgical populations. Supplement users should note that intravenous administration during surgery differs from oral supplementation, and benefits may not extend to non-deficient individuals or other surgical contexts. Always consult a healthcare provider before perioperative interventions.

Note: This analysis focuses on thiamine’s role within the B complex; the study did not isolate individual B1 effects.