The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Cardiac Surgery

Abstract

Objective: The purpose of this systematic review and meta-analysis is to examine the effect of DEX on delayed dNCR (cognitive dysfunction ! 1 week postoperative) after cardiac surgery. Background: DEX has salutary effects on cognitive outcomes following cardiac surgery, however, studies are limited by inconsistent assessment tools, timing, and definitions of dysfunction. It is imperative to identify accurate point estimates of effect of DEX on clinically relevant changes in cognitive function. Methods: Randomized trials of adults undergoing cardiac surgery comparing perioperative DEX to placebo or alternate sedation and assessing cognitive function !1 week postoperative were included. Data was abstracted by three reviewers independently and in parallel according to PRISMA guidelines. The primary outcome is dNCR. To classify as dNCR, cognitive function must decrease by at least the minimal clinically important difference or accepted alternate measure (eg, Reliable Change Index !1.96). Bias was assessed with the Cochrane Collaboration tool. Data was pooled using a random effects model. Results: Nine trials (942 participants) were included in qualitative analysis, of which seven were included in the meta-analysis of dNCR. DEX reduced the incidence of dNCR (OR 0.39, 95% CI 0.25-0.61, P < 0.0001) compared to placebo/no DEX. There was no difference in the incidence of delirium (OR 0.69, 95% CI 0.35-1.34, P ¼ 0.27) or incidence of hemodynamic instability (OR 1.14, 95% CI 0.59-2.18, P ¼ 0.70) associated with perioperative DEX. Conclusions: DEX reduced the incidence of dNCR 1 week after cardiac surgery. Although this meta-analysis demonstrates short term cognitive outcomes are improved after cardiac surgery with perioperative DEX, future trials examining long term cognitive outcomes, using robust cognitive assessments, and new perioperative neurocognitive disorders nomenclature with objective diagnostic criteria are necessary.

Sedation Efficacy of Remimazolam Besylate in Elderly Patients Undergoing Non-general Anesthesia and Effects on Perioperative Cognitive Function: A Clinical Trial Protocol

“…With a relatively slow onset of action, a longer awakening time, a tendency to accumulate with prolonged infusion, and an increased risk of postoperative delirium, midazolam has little effect on respiration or circulation [20] . Dexmedetomidine, as an α2-adrenergic receptor agonist, reduces the incidence of postoperative delirium, but inevitably produces adverse effects of bradycardia [21] . In light of its unique pharmacokinetic and pharmacodynamic properties, remimazolam besylate has many clinical advantages as a novel ultrashort-acting benzodiazepine., Promising to be an ideal sedative drug, remimazolam besylate is effective in relieving patient tension in the operating room; has a rapid onset of action, fast metabolism, low cardiovascular depression, and does not accumulate in long-term infusions [22][23][24][25][26] .…”