Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Xiong, Xinglong; Chen, Dong Xu; Shi, Jing

doi:10.3389/fmed.2021.645975

Cited by 10 publications

(21 citation statements)

References 53 publications

(137 reference statements)

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“…17 and Xiong et al had opposite findings and the result of pooled studies was found to be in favor of dexmedetomidine in reducing POD in cardiac surgery patients. 18,19 Thus the literature is largely conflicted.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

Ain

Kirmani²,

Siddique³

et al. 2022

PAFMJ

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Objective: To find out the frequency of delirium associated with peri-operative use of dexmetedomidine and propofol in post CABG patients. Study Design: Comparative Cross-sectional study. Place and Duration of Study: Adult Intensive Care unit, Department of Cardiac Anesthesiology and Intensive Care, Armed Force Institute of Cardiology, Rawalpindi Pakistan from Feb to Jun 2022. Methodology: All post CABG patients who have undergone elective surgery were included through non-probability consecutive sampling technique. All the delirious patients amongst them were subjected to a modified version of ICU-CAM to establish post-operative delirium (POD) caused by either dexmedetomidine or propofol. POD in both the category of patients was compared. Results: A total of 179 CABG patients were included in our study. 140(78.2%) of the patients were subjected to the use of dexmedetomidine throughout their surgery while 39(21.8%) of the patients were given propofol. After subjecting the patients to our exclusion criteria which aimed to eliminate the confounding causes of POD in post-CABG patients, only 30(16.8%) had delirium while 149(83.2%) didn’t develop delirium (p-value=0.003). Majority of the delirious patients were given dexmedetomidine (n=29; 20.77%) in the operation theatre while only a fraction (n=1; 2.58%) were given propofol. Average duration of ICU stay in our study population was 5 days. 15(8.4%) cases out of our total study population underwent reintubation and re-ventilation because of low cardiac output or respiratory distress. Conclusion: Dexmedetomidine could possibly be associated with POD in patients undergoing cardiac surgery. Propofol on the other hand is considerably safe in this regard and doesn’t cause POD.

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Section: Discussionmentioning

confidence: 99%

Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

Ain

Kirmani²,

Siddique³

et al. 2022

PAFMJ

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“…Therefore, these results suggest that dexmedetomidine may reduce the extent of brain insult following cardiac surgery. Xiong et al ( 188 ) conducted a systematic review on the effects of dexmedetomidine on perioperative neurocognitive disorders. With data from 3610 patients collated from 24 studies, they detected no significant difference in the incidence of POCD between dexmedetomidine and the control group (OR: 0.47, 95% CI: 0.22–1.03, p = 0.060).…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

“…It should be noted that numerous studies may have used an insufficient maintenance dose of dexmedetomidine, ranging between 0.2–0.5 ug/kg/hr of dexmedetomidine. In contrast, there was a significant reduction in the incidence of postoperative delirium in the dexmedetomidine group compared to the control group (OR: 0.59, 95% CI: 0.43–0.82, p = 0.001) ( 188 ).…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015–present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.

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“…We checked the eligibility of all studies from previous meta-analyses and updated literature search according to the following criteria [12][13][14][15] : (1) adult patients were assigned to receive cardiac surgery, regardless of types of surgeries;…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…However, the optimal time of applying dexmedetomidine to prevent the occurrence of POD in patients undergoing cardiac surgery was still not investigated in these meta-analyses. 14,15 Unfortunately, to our knowledge, there was no study directly compared the different administration time of dexmedetomidine. Therefore, it is impossible to determine the optimal administration time of dexmedetomidine in patients undergoing cardiac surgery from pairwise meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Application of Dexmedetomidine is the Optimal Strategy to Reduce the Incidence of Postoperative Delirium After Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials

2022

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Background: Previous pairwise meta-analyses demonstrated the efficacy and safety of dexmedetomidine in preventing postoperative delirium (POD) after cardiac surgery; however, the optimal time of applying dexmedetomidine remains unclear. Objective: This network meta-analysis aimed to determine the optimal time of using dexmedetomidine to reduce the incidence of POD following cardiac surgery. Methods: We first retrieved eligible randomized controlled trials (RCTs) from previous meta-analyses, and then an updated search was performed to identify additional RCTs in PubMed, Embase, and the Cochrane library from January 1, 2021 to October 31, 2021. Two authors screened literature, collected data, and evaluated bias risk of eligible studies. Finally, we performed Bayesian network analysis using R version 3.6.1 with the “gemtc” and “rjags” package. Results: Eighteen studies with 2636 patients were included, and all studies were identified from previous meta-analyses. Results showed that postoperative dexmedetomidine reduced the risk of POD compared with normal saline (NS) (odds ratio [OR], 0.13; 95% credible interval [CrI], 0.03-0.35) and propofol (PRO) (OR, 0.19; 95%CrI, 0.04-0.66). Postoperative dexmedetomidine was associated with a lower incidence of POD compared with perioperative dexmedetomidine (OR, 0.21; 95% CrI, 0.04-0.82). Moreover, postoperative dexmedetomidine had the highest probability of ranking best (90.98%), followed by intraoperative dexmedetomidine (46.83%), PRO (36.94%), perioperative dexmedetomidine (30.85%), and NS (60.02%). Conclusion and Relevance: Dexmedetomidine reduces the incidence of POD compared with PRO and NS in patients undergoing cardiac surgery, and postoperative application of dexmedetomidine is the optimal time.

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Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Cited by 10 publications

References 53 publications

Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Postoperative Application of Dexmedetomidine is the Optimal Strategy to Reduce the Incidence of Postoperative Delirium After Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials

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