&lt;p&gt;Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: a double-blinded, multi-center, randomized study&lt;/p&gt;

Shi, Cunxian; Jin, Jin; Qiao, Leyan; Li, Tao; Ma, Jiahai; Ma, Zhikun

doi:10.2147/cia.s194476

Cited by 46 publications

(82 citation statements)

References 24 publications

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“…This is in contrast with previous meta-analyses that found a reduction in delirium incidence with the perioperative use of dexmedetomidine [1,[32][33]. A possible explanation for this result is that our analysis included a more recent trial that favored propofol over dexmedetomidine [29] and could have in uenced the results.…”

Section: Discussioncontrasting

confidence: 75%

Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

Abowali¹,

Paganini²,

Enten³

et al. 2020

Preprint

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Background The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries are controversial when compared to propofol. Methods A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed through July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were selected. The primary study outcomes were divided into time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes of heart valve surgery and CABG patients. Additionally, time-dependent outcomes are affected by several confounding factors, and more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes.

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Section: Discussioncontrasting

confidence: 75%

Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

Abowali¹,

Paganini²,

Enten³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 75%

Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

Abowali¹,

Paganini²,

Enten³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

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“…There was no significance in incidence of POD between the dexmedetomidine group and the propofol group, 39.3% versus 26.3% respectively. In patients treated with dexmedetomidine, the median onset time of delirium was delayed (second day vs first day) and the duration of delirium reduced (2 days vs 3 days) when compared with propofol-treated patients [16]. The incidence of delirium in this study was higher than our results (39.3% versus 27.3% respectively), however the onset and duration of delirium in patients who received dexmedetomidine were comparable to our results.…”

Section: Discussionsupporting

confidence: 57%

Postoperative delirium after coronary artery bypass graft surgery: Dexmedetomidine infusion alone or with the addition of oral melatonin

Mahrose

El-Serwi

Maurice

et al. 2021

Egyptian Journal of Anaesthesia

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Introduction: Postoperative delirium is a common complication of cardiac surgery. This study aimed to assess the effect of supplementing dexmedetomidine infusion with oral melatonin in prevention of postoperative delirium after coronary artery bypass graft surgery. Methods: 110 patients of both sexes above 60 years of age were included. Anesthetic management was standardized. Patients were randomly allocated into one of the two study groups, dexmedetomidine/melatonin (DM) group or dexmedetomidine (D) group. Patients in the DM group received oral Melatonin tablet 5 mg the night before surgery and same dose was repeated every 24 hours for 3 postoperative days. After completion of surgery and upon ICU arrival, patients in both groups received a bolus of 0.4 µg/kg dexmedetomidine followed by 0.2-0.7 µg/kg/h infusion, for 24 maximum hours. Delirium was assessed for 5 days postoperatively at 12 hr intervals using confusion assessment method (CAM) for ICU and after discharge from ICU to surgical ward using CAM. Delirious patients were treated with IV haloperidol. Results: No significant differences between studied groups regarding baseline, preoperative, intraoperative and postoperative characteristics. Incidence of delirium was significantly lower, onset significantly more delayed, and duration was significantly shorter in group-DM as compared to group-D. No significant differences between all cases, cases who had delirium, and cases who did not have delirium in the two groups as regards extubation time, ICU stay, and hospital stay. Conclusion: supplementing dexmedetomidine with melatonin decreases incidence, delays onset, and shortens duration of postoperative delirium in patients above 60 years of age undergoing CABG surgery.

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<p>Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: a double-blinded, multi-center, randomized study</p>

Cited by 46 publications

References 24 publications

Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

Postoperative delirium after coronary artery bypass graft surgery: Dexmedetomidine infusion alone or with the addition of oral melatonin

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