<p>Impact of postoperative dexmedetomidine infusion on incidence of delirium in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial</p>

Abstract

PurposePostoperative delirium is a serious and common complication, it occurs in 13–50% of elderly patients after major surgery, and presages adverse outcomes. Emerging literature suggests that dexmedetomidine sedation in critical care units (intensive care unit) is associated with reduced incidence of delirium. However, few studies have investigated whether postoperative continuous infusion of dexmedetomidine could safely decrease the incidence of delirium in elderly patients admitted to general surgical wards after noncardiac surgery.Patients and methodsThis double-blind, randomized, placebo-controlled trial was conducted in patients aged 65 years or older undergoing major elective noncardiac surgery without a planned ICU stay. Eligible patients were randomly assigned to receive either dexmedetomidine (0.1 μg/kg/h) or placebo (0.9% normal saline) immediately after surgery though patient-controlled intravenous analgesia device. The primary outcome was the incidence of delirium during the first 5 postoperative days. Secondary outcomes included postoperative subjective pain scores and subjective sleep quality. The study dates were from January 2018 to January 2019.ResultsA total of 557 patients were randomly assigned to receive either dexmedetomidine (n=281) or placebo (n=276). The incidence of postoperative delirium had no difference between the dexmedetomidine and placebo groups (11.7% [33 of 281] vs 13.8% [38 of 276], P=0.47). Compared with placebo group, patients in dexmedetomidine group reported significant lower numerical rating score pain scores at 3, 12, 24, and 48 hrs after surgery (all P<0.05) and significant improved Richards Campbell Sleep Questionnaire results during the first 3 postoperative days (all P<0.0001). Dexmedetomidine-related adverse events were similar between the two groups.ConclusionPostoperative continuous infusion of dexmedetomidine did not decrease the incidence of postoperative delirium in elderly patients admitted to general surgical wards after elective noncardiac surgery.

Effect of Dexmedetomidine on Delirium in Elderly Surgical Patients: A Meta-analysis of Randomized Controlled Trials

“…Eight of 21 studies administered loading doses, which were 0.4, 21 0.5, 32,33 0.6, 22,38 0.8 to 0.1, 34 and 1 31,35 µg/kg, accordingly. In our included studies, the infusion rates were 0.1, 14-16,36,39 0.2, 13 0.4, 32,33 0.5, 26,35,38 0.2 to 0.4, 37 0.2 to 0.7, 17,21,30,31 0.1 to 0.5, 34 0.4 to 0.6, 24 0.1 to 1.2, 25 and 0.1 to 0.7 23 µg/kg/h, accordingly. One study 22 exhibited infusion rates for dexmedetomidine of 0.4 and 0.1 µg/kg/h.…”

Perioperative Sleep Disturbances and Postoperative Delirium in Adult Patients: A Systematic Review and Meta-Analysis of Clinical Trials

“…There were seven trials and 52,369 patients in the ROT group ( 16 , 27 – 32 ), 12 trials and 1,435 patients in the POT group ( 33 – 44 ), and 10 trials and 2,103 patients in the RCT group ( 17 , 18 , 45 – 52 ). Tables 1 , 2 presented the basic characteristics of the observational studies (retrospective and prospective) and RCTs, respectively.…”

“…In one retrospective trial, the control group was matched for age, sex, operated side, type of operation, mode of component fixation, year of operation, surgeon, and type of anesthesia ( 28 ). In seven trials, patients only underwent cardiac surgery ( 33 , 36 – 39 , 42 , 44 ), in 20 trials, only non-cardiac surgeries ( 17 , 18 , 27 – 30 , 32 , 34 , 35 , 40 , 41 , 43 , 45 – 52 ), and in two trials, both cardiac and non-cardiac surgeries ( 16 , 31 ). All the patients in the included RCTs underwent non-cardiac surgeries.…”

“…We obtained the mean age of patients in each study by adding the mean age of patients in each group and then dividing by two. In 19 trials, the mean age was 65 years or older ( 17 , 18 , 28 , 30 – 32 , 34 , 35 , 37 – 40 , 45 , 46 , 48 – 52 ), though one trial did not provide participants' ages ( 36 ). Males accounted for 50% or more of all patients in 16 trials ( 16 – 18 , 28 , 31 , 33 , 35 , 37 – 39 , 41 – 45 , 47 ), though two trials did not provide sex-related information ( 36 , 51 ).…”

“…Many of the included studies demonstrated low risk of bias, as they clearly assessed random sequence generation (seven studies-70%), allocation concealment (eight studies-80%), blinding of participants (seven studies-70%), blinding of outcome assessment (10 studies-100%), incomplete outcome data (nine studies-90%), and selective outcome reporting (nine studies-90%). Six RCTs were found to be high quality ( Supplementary Figures 1 , 2 ) ( 17 , 18 , 46 – 48 , 51 ).…”