Efficacy and Safety of Dexmedetomidine for Postoperative Delirium in Adult Cardiac Surgery on Cardiopulmonary Bypass

Abstract

BackgroundDelirium after cardiac surgery is associated with serious long-term negative outcomes and high costs. The aim of this study is to evaluate neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine, compared with the current postoperative sedative protocol (remifentanil) in patients undergoing open heart surgery with cardiopulmonary bypass (CPB).MethodsOne hundred and forty two eligible patients who underwent cardiac surgery on CPB between April 2012 and March 2013 were randomly divided into two groups. Patients received either dexmedetomidine (range, 0.2 to 0.8 μg/kg/hr; n=67) or remifentanil (range, 1,000 to 2,500 μg/hr, n=75). The primary end point was the prevalence of delirium estimated daily via the confusion assessment method for intensive care.ResultsWhen the delirium incidence was compared with the dexmedetomidine group (6 of 67 patients, 8.96%) and the remifentanil group (17 of 75 patients, 22.67%) it was found to be significantly less in the dexmedetomidine group (p<0.05). There were no statistically significant differences between two groups in the extubation time, ICU stay, total hospital stay, and other postoperative complications including hemodynamic side effects.ConclusionThis preliminary study suggests that dexmedetomidine as a postoperative sedative agent is as sociated with significantly lower rates of delirium after cardiac surgery.

Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting

“…Patients receiving dexmedetomidine were significantly less likely than those receiving remifentanil to experience delirium (Table 2) [44]. There were no significant differences between dexmedetomidine and remifentanil recipients in the length of delirium or ICU stay, or the time to extubation ( Table 2) [44].…”

“…The delirium endpoint refers to the prevalence of delirium over the 12-day study period [42] or the proportion of pts developing delirium within 3 [44,45] or 5 [43] days of surgery d Median [42,43] or mean [44,45] e Primary endpoint f Intubation time and coma-free days than patients receiving lorazepam (Table 2) [42]. The median number of coma-free days was significantly greater with dexmedetomidine than with lorazepam (10 vs. 8 days; p \ 0.001), with no significant between-group difference in the median number of deliriumfree days (9 vs. 7 days).…”

“…Two trials (MENDS [42] and DEXCOM [43]) were of randomized, double-blind, multicentre design and two trials were of randomized, openlabel, single-centre design [44,45]. Trials included postcardiac surgery patients [43][44][45] or surgical and medical patients [42] who required ventilation and sedation in an intensive care setting. Treatment regimen details are shown in Table 2.…”

“…This section focuses on trials primarily designed to compare the effect of dexmedetomidine on delirium with that of lorazepam [42], morphine [43], remifentanil [44] and propofol or midazolam [45]. Two trials (MENDS [42] and DEXCOM [43]) were of randomized, double-blind, multicentre design and two trials were of randomized, openlabel, single-centre design [44,45].…”

“…Treatment regimen details are shown in Table 2. Primary endpoints included the incidence of postoperative delirium [43][44][45] and the number of delirium-and coma-free days [42].…”