Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: A meta-analysis of randomized controlled trials

Abstract

Background The role of dexmedetomidine in preventing delirium after cardiac surgery remains controversial because of several recent trials with negative results. We aimed to perform an updated meta-analysis of randomized controlled trials (RCTs) to clarify this controversy. Methods RCTs investigating the perioperative administration of dexmedetomidine in cardiac surgery were retrieved from PubMed, Web of Science, and the Cochrane library until August,27,2020. Two researchers independently screened the literature, collected the data and evaluated the bias risk of the included studies. The meta-analysis was performed with the RevMan 5.3. Results A total of 15 studies including 2813 patients were included in the study. A pooled result showed that dexmedetomidine could reduce the risk of delirium in adult population underwent cardiac surgery (OR 0.56, 95%CI 0.35–0.89, P = 0.0003, I = 64%). The subgroup analysis demonstrated that the protective effect of dexmedetomidine was only present in the patients injected with dexmedetomidine after surgery but not from the start of surgery, in the adult patients without specific age limitation but not in the elderly, and in the studies in comparison with other sedatives but not with placebo. There were no statistical differences when analyzing the secondary outcomes including hypotension (OR 1.13; 95% CI 0.54–2.37, P < 0.00001, I²=85%), bradycardia (OR 1.72; 95% CI 0.84–3.53, P = 0.04, I²=58%) and atrial fibrillation (OR 0.87; 95% CI 0.70–1.08, P = 0.43, I²=0). Conclusions Dexmedetomidine can reduce the incidence of delirium compared to other sedatives and opioids after cardiac surgery in adult patients. The proper population and timing for perioperative use of dexmedetomidine after cardiac surgery remain to be further investigated.

Year in Review 2021: Noteworthy Literature in Cardiothoracic Critical Care

“…Postoperative delirium (POD) remains an important topic in clinical research, as up to 53% of patients who undergo major surgery have been shown to experience some level of cognitive dysfunction. 1 Multiple publications over the last year attempted to identify predictors of postoperative delirium, examining risk factors throughout the perioperative period.…”

“…Falk et al 3 Preoperative diagnosis of depression is a prevalent and potentially modifiable risk factor for POD. Li et al 1 Dexmedetomidine provides adequate sedation and reduces POD compared to other common sedatives.…”

“…A recent review of fifteen studies that included over 2800 patients identified that the use of dexmedetomidine provided adequate sedation with a potential reduction in the development of POD by up to 44% when compared to opioids and other sedating medications. 1 In a recent double-blinded randomized controlled trial, researchers compared dexmedetomidine to a true control, normal saline. After analyzing the results from the 102 study participants, dexmedetomidine showed some benefit, including a reduced length of stay and improved pain scores.…”

Cardiac surgery, ICU sedation, and delirium: is dexmedetomidine the silver bullet?

“…Indeed, several meta-analyses have been published on this topic in recent years (Table 3). An updated meta-analysis by Li et al , which searched through August 2020 and incorporated DECADE and DEXACET, found strong summary evidence for dexmedetomidine's role in reducing delirium after cardiac surgery [23 ▪▪ ]. This meta-analysis attempted to separate effective and ineffective trials by performing several subgroup analyses, recognizing that the substantial heterogeneity in population and dose created unfortunate complexity to the message for clinicians.…”

Remifentanil versus Dexmedetomidine in Cardiac Surgery Patients with Noninvasive Ventilation Intolerance: Protocol for the REDNIVI Trial

“…Dexmedetomidine (DEX) is a selective α-2 agonist that downregulates the release of norepinephrine in the central nervous system without suppressing breathing [19]. It is being widely used with good safety in CS patients [20,21]. And it is the standard sedation protocol adopted at Zhongshan Hospital, Fudan University.…”