Efficacy of perioperative dexmedetomidine in postoperative neurocognitive function: a meta‐analysis

Abstract

Neuroprotective effects of dexmedetomidine are reported in preclinical and clinical studies but evidence regarding the postoperative neurocognitive function is not as clear. This study performed a meta-analysis on outcomes of studies which examined neurocognitive performance by using valid assessment tools before and after perioperative dexmedetomidine treatment. Literature was searched in several electronic databases and studies were selected by following précised inclusion criteria. Meta-analyses of mean differences in percent changes from baseline in neurocognitive assessment scores were carried out and subgroup analyses were performed. Eighteen studies were included. Initial dose of dexmedetomidine (mean ± SD) was 1.28 ± 0.97 μg/kg and maintenance dose was 0.41 ± 0.11 μg/kg per hour. In healthy volunteers, there was no significant difference in the neurocognitive performance between dexmedetomidine and controls/comparators (mean difference (95% confidence interval (CI)): -12.72 (-50.25, 24.80) %; P = 0.51). Perioperative dexmedetomidine treatment was associated with significantly better neurocognitive performance in comparison with saline (mean difference (95% CI): 9.10 (3.03, 15.16) %; P = 0.003) as well as with comparator anaesthetics (mean difference: 5.50 (0.15, 10.86) %; P = 0.04) treated patients. In the submeta-analyses of studies which utilized neurocognitive assessment tools other than Mini-Mental State Examination (mean difference: 6.66 (-3.42, 16.74); P = 0.20) or studies with patients under 60 years of age (mean difference: 7.48 (-3.00, 17.96); P = 0.16), the differences were not significant between dexmedetomidine- and saline-/comparator-treated patients. Perioperative dexmedetomidine treatment is associated with significantly better neurocognitive function postoperatively in comparison with both saline controls and comparator anaesthetics (predominantly midazolam).

Does dexmedetomidine given as a premedication or intraoperatively reduce post-hospitalisation behaviour change in children? A study protocol for a randomised controlled trial in a tertiary paediatric hospital

“…There is also growing evidence that dexmedetomidine is neuroprotective in both animal and human models. A meta-analysis by Man et al 28 found adults who had an intraoperative dose of dexmedetomidine had better neurocognitive outcomes compared with placebo and midazolam. Another meta-analysis by Pasin et al 29 examined critically ill patients in an intensive care setting and found dexmedetomidine reduced the incidence of agitation, confusion and delirium compared with control.…”

Sensations of patients and their satisfaction during awake craniotomy

“…Он также стабилизирует системную гемодинамику, не влияя на объемный мозговой кровоток и церебральный метаболизм, не изменяя нативную электроэнцефалограмму у пациентов с эпилепсией [62]. Недавно опубликованный метаанализ показал, что дексмедетомидин также улучшает состояние нейрокогнитивных функций в послеоперационном периоде, в особенности у пациентов старше 65 лет [63].…”

Dexmedetomidine for the management of delirium in critically ill patients—A protocol for a systematic review

“…Dexmedetomidine may enable patients to communicate better with care-givers (e.g. report pain, nausea) (29,30,36), decrease pain, nausea, neuroinflammation, reduce the use of other sedatives and analgesics, reduce the duration of mechanical ventilation and ICU length of stay (29,30,34,(36)(37)(38)(39)(40)(41), promote natural sleep by inhibiting noradrenergic neurons in the locus coeruleus (42), and may provide neuroprotection (29,(31)(32)(33).…”