Perioperative Dexmedetomidine Supplement Decreases Delirium Incidence After Adult Cardiac Surgery: A Randomized, Double-Blind, Controlled Study

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

“…Specific to our study design, four studies concentrated on cardiac valve surgery ( 24 , 26 , 28 , 34 ), 15 studies included combined CABG and valve surgeries ( 10 , 16 – 23 , 25 , 27 , 29 , 31 , 33 , 37 ), and the remaining five studies related to CABG ( 15 , 30 , 32 , 35 , 36 ). Dexmedetomidine was administered during the intraoperative period in six studies ( 26 – 29 , 31 , 35 ), the perioperative period in eight studies ( 10 , 15 , 23 – 25 , 33 , 34 , 37 ), and the other 10 studies during the postoperative period ( 16 – 22 , 30 , 32 , 36 ). CAM/CAM-ICU was used in nine studies as the diagnostic tool for POD ( 16 , 18 , 20 , 23 , 25 , 30 – 33 ) and five studies used RASS ( 10 , 17 , 19 , 21 , 22 ).…”

“…Dexmedetomidine was administered during the intraoperative period in six studies ( 26 – 29 , 31 , 35 ), the perioperative period in eight studies ( 10 , 15 , 23 – 25 , 33 , 34 , 37 ), and the other 10 studies during the postoperative period ( 16 – 22 , 30 , 32 , 36 ). CAM/CAM-ICU was used in nine studies as the diagnostic tool for POD ( 16 , 18 , 20 , 23 , 25 , 30 – 33 ) and five studies used RASS ( 10 , 17 , 19 , 21 , 22 ). The following tools were used to diagnose POD in a single trial each: the modified Hewitt questionnaire ( 15 ), the DSM-IV-TR ( 24 ), the DRS ( 26 ), and the ICDSC ( 37 ).…”

“…The incidence of POD was reported in 19 studies ( 10 , 15 – 25 , 29 – 33 , 36 , 37 ), four studies reported the incidence of POCD ( 27 , 28 , 34 , 35 ), and one study reported the incidence of both ( 26 ). Dexmedetomidine was demonstrated to reduce the incidence of POCD in three of four studies ( 27 , 34 , 35 ), 14 studies reported that dexmedetomidine decreased the incidence of POD ( 16 – 21 , 23 , 24 , 29 , 30 , 32 , 33 , 36 , 37 ), and one study found that dexmedetomidine reduced the risk of both POD and POCD ( 26 ).…”

“…Subgroup analyses were performed for different types of surgery, comprising three studies ( 23 , 24 , 26 ) with 208 patients conducted on cardiac valve surgery, 14 studies ( 10 , 16 – 23 , 25 , 29 , 31 , 33 , 37 ) with 2,443 patients focused on mixed cardiac surgery, and five studies ( 15 , 23 , 30 , 32 , 36 ) with 646 patients regarding CABG surgery. The forest plot revealed that there was no significant difference in POD incidence in cardiac valve surgery (OR: 0.34, 95% CI: 0.08–1.45, I 2 = 52.6%, P = 0.146), while the POD incidence of dexmedetomidine-treated patients was significantly lower in mixed cardiac surgery (OR: 0.68, 95% CI: 0.47–0.98, I 2 = 44.4%, P = 0.039) and CABG surgery (OR: 0.45, 95% CI: 0.26–0.79, I 2 = 0.0%, P = 0.005) ( Supplementary 2: Figure 4A ).…”

“…Additional subgroup analyses were performed for different times (relative to the cardiac operations) and the duration of dexmedetomidine administration. These included three studies ( 26 , 29 , 31 ) involving 284 patients that were given dexmedetomidine during the intraoperative period; seven studies ( 10 , 15 , 23 – 25 , 33 , 37 ) with 1,687 patients treated in the perioperative period; while dexmedetomidine infusion postoperatively occurred in 10 studies ( 16 – 22 , 30 , 32 , 36 ) with 1,326 patients. The forest plot revealed that there was no significant difference in POD incidence in the “intraoperative period” and the “perioperative period” subgroups; however, the POD incidence was significantly lower when dexmedetomidine was used during the postoperative period (OR: 0.48, 95% CI: 0.34–0.67, I 2 = 0.0%, P < 0.001) ( Supplementary 2: Figure 5A ).…”