Intravenous infusion of dexmedetomidine during the surgery to prevent postoperative delirium and postoperative cognitive dysfunction undergoing non-cardiac surgery: A meta- analysis of randomized controlled trials

Abstract

Background Dexmedetomidine is crucial for preventing postoperative delirium and cognitive dysfunction and improving the quality of life of surgical patients. However, the effects of dexmedetomidine on these complications in different anesthesia methods have not been thoroughly evaluated. Thus, we conducted a meta-analysis to assess its impact on postoperative delirium and cognitive dysfunction. Methods We searched PubMed, Embase, and Cochrane Library for randomized controlled trials comparing intravenous dexmedetomidine to other interventions in preventing postoperative delirium and cognitive dysfunction in non-cardiac and non-neurosurgical patients. Statistical analysis and graphing were performed using Review Manager, STATA, the second version of the Cochrane risk-of-bias tool for randomized controlled trials, and GRADE profiler. Main results This meta-analysis comprised a total of 24 randomized controlled trials, including 20 trials assessing postoperative delirium and 6 trials assessing postoperative cognitive dysfunction. In these 20 studies, a positive correlation was found between intravenous infusion of dexmedetomidine and the lower incidence of postoperative delirium (RR: 0.55; 95%CI: 0.47 to 0.64, p＜ 0.00001, I2 = 2%) and postoperative cognitive dysfunction(RR: 0.60; 95%CI: 0.38 to 0.96, p = 0.03, I2 = 60%). Subgroup analysis did not reveal a significant difference in the incidence of postoperative delirium between the general anesthesia and non-general anesthesia groups, but a significant difference was observed in the incidence of postoperative cognitive dysfunction. However, pooled data showed that the use of dexmedetomidine increased the incidence of hypotension (RR: 1.42; 95%CI:1.08 to 1.86, p =0.01, I2 = 0%) and bradycardia (RR: 1.66; 95%CI: 1.23 to 2.26, p =0.001, I2 = 0%) compared with other interventions but there is no significantly higher occurrence of hypertension in DEX groups (RR=1.35, 95% CI :0.81–2.24, p=0.25, I2= 0%). Conclusion Intravenous dexmedetomidine infusion during non-cardiac and non-neurosurgical procedures may significantly reduce the risk of postoperative delirium and cognitive dysfunction compared to other interventions. Subgroup analysis revealed a consistent preventive effect on postoperative delirium in both general and non-general anesthesia groups, while continuous infusion during general anesthesia was more effective in reducing the risk of cognitive dysfunction. However, hypotension and bradycardia were more frequent in patients who received dexmedetomidine during surgery.