Effects of dexamethasone on early cognitive decline after cardiac surgery

Glumac, Sandro; Kardum, Goran; Šodić, Lidija; Šupe‐Domić, Daniela; Karanović, Nenad

doi:10.1097/eja.0000000000000647

Cited by 82 publications

(143 citation statements)

References 31 publications

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“…Two studies reported the duration of hospitalization (measured in days) [22,23]. Our meta-analysis showed that the use of dexamethasone reduced the length of hospital stay (WMD -0.57 d; 95% CI [-1.08, -0.07], P =0.03, I2 = 0%, Figure 6), but the difference was so small that it did not has a clinical significance.…”

Section: Secondary Outcomesmentioning

confidence: 76%

“…Table 1 shows the characteristics of the included studies. Four of the included studies involved cardiac surgery [22][23][24][25], while the remaining one involved microvascular decompression surgery [26].…”

Section: Study Selectionmentioning

confidence: 99%

“…Four studies used a two-arm design in comparing dexamethasone to placebo except 1, which used a three-arm design [26]. Three studies assessed the effects of dexamethasone on POCD [22,24,26], while two studies investigated the effects of dexamethasone on POD [23,25].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies reported the incidence of POCD, in which data was reported as the number of participants [22,24,26]. Fang and 538 participants in placebo group, which accounted for 95% of the total 1460 enrolled participants.…”

Section: Incidence Of Pocdmentioning

confidence: 99%

“…Only one study reported the level of CRP [22], which was measured 12 hours after surgery and on the each of the first 3 postoperative days; the CRP level was lower in the dexamethasone group compared with the placebo group at all time points (P < 0.001). We deem the evidence for this outcome to be of very low quality based on the limited evidence available.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Fang

et al. 2019

Preprint

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Background Several studies have investigated the effects of dexamethasone on postoperative cognitive dysfunction (POCD) or postoperative delirium (POD); however, their conclusions have not been consistent. So we conducted a meta-analysis to determine the effects of dexamethasone on POCD/POD in adults following general anesthesia. Methods Cochrane Central Register of Controlled Trials (CENTRAL, 2018, Issue 11 of 12) in the Cochrane Library (searched November 17, 2018); MEDLINE OvidSP (1946 to November 16, 2018); and Embase OvidSP (1974 to November 16, 2018) were searched for randomized controlled trials that evaluated the incidence of POCD/POD following dexamethasone administration, in adults (age ≥18 years) under general anesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess the quality of evidence. Results Five studies were included (three studies/855 participants in dexamethasone group and 538 participants in placebo group for the incidence of POCD, and two studies/410 participants in dexamethasone group and 420 participants in placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD in 30 days after surgery (RR 1.00; 95% CI [0.51, 1.96], P = 1.00, I2 = 77%) or in the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I2 = 0%). However, both analyses had some limitations since evidence remains limited and clinical heterogeneity, and we considered the quality of the evidence for the postoperative incidence of POCD and POD to be very low. Conclusions This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative prevent strategies for POCD/POD, and a better understanding of the pathophysiology of those complex syndrome, are still needed to make progress of this field. Trial registration number: This study is registered with PROSPERO, 23 October 2018, number CRD42018114552.

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Section: Secondary Outcomesmentioning

confidence: 76%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Incidence Of Pocdmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

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Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Fang

et al. 2019

Preprint

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Prophylactic corticosteroids for cardiopulmonary bypass in adult cardiac surgery

Abbasciano,

Olivieri,

Chubsey

et al. 2024

Cochrane Database of Systematic Reviews

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Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass

Gibbison

Villalobos-Lizardi

Martínez

et al. 2020

Cochrane Database of Systematic Reviews

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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of prophylactic corticosteroids in children between birth and 18 years of age undergoing cardiac surgery with cardiopulmonary bypass. B A C K G R O U N D Description of the condition Paediatric heart surgery outcomes have improved markedly over time as a result of marginal gains in training, technology and safety systems (Brown 2015; Hoashi 2015; Jacobs 2016; NICOR 2016). This improvement has been particularly notable in the last 20 years: the publication of heart surgery outcomes after the Kennedy Inquiry in the UK has been associated with a large increase in survival for risk-adjusted surgery (Kennedy 2001; Grant 2013). This has been mirrored worldwide (Brown 2015; Hoashi 2015; Jacobs 2016). One area where there is still controversy is corticosteroid use. Paediatric heart surgery with the use of cardiopulmonary bypass results in a systemic inflammatory response; corticosteroids have been widely used to mitigate the potential deleterious effects of this response. The surgical intervention for which corticosteroids are used includes a variety of surgeries performed on the heart and great vessels. In most cases this procedure aims to correct congenital heart diseases (i.e. heart malformations that the child is born with). In most cases (78% in the UK) (NICOR 2016), surgery will take place with the use Cardio-Pulmonary By-1 Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass (Protocol)

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Effects of dexamethasone on early cognitive decline after cardiac surgery

Abstract: Clinicaltrials.gov identifier: NCT02767713.

Cited by 82 publications

References 31 publications

Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Prophylactic corticosteroids for cardiopulmonary bypass in adult cardiac surgery

Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass

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