The Influence of Perioperative Dexmedetomidine on Patients Undergoing Cardiac Surgery: A Meta-Analysis

Abstract

BackgroundThe use of dexmedetomidine may have benefits on the clinical outcomes of cardiac surgery. We conducted a meta-analysis comparing the postoperative complications in patients undergoing cardiac surgery with dexmedetomidine versus other perioperative medications to determine the influence of perioperative dexmedetomidine on cardiac surgery patients.MethodsRandomized or quasi-randomized controlled trials comparing outcomes in patients who underwent cardiac surgery with dexmedetomidine, another medication, or a placebo were retrieved from EMBASE, PubMed, the Cochrane Library, and Science Citation Index.ResultsA total of 1702 patients in 14 studies met the selection criteria among 1,535 studies that fit the research strategy. Compared to other medications, dexmedetomidine has combined risk ratios of 0.28 (95% confidence interval [CI] 0.15, 0.55, P = 0.0002) for ventricular tachycardia, 0.35 (95% CI 0.20, 0.62, P = 0.0004) for postoperative delirium, 0.76 (95% CI 0.55, 1.06, P = 0.11) for atrial fibrillation, 1.08 (95% CI 0.74, 1.57, P = 0.69) for hypotension, and 2.23 (95% CI 1.36, 3.67, P = 0.001) for bradycardia. In addition, dexmedetomidine may reduce the length of intensive care unit (ICU) and hospital stay.ConclusionsThis meta-analysis revealed that the perioperative use of dexmedetomidine in patients undergoing cardiac surgery can reduce the risk of postoperative ventricular tachycardia and delirium, but may increase the risk of bradycardia. The estimates showed a decreased risk of atrial fibrillation, shorter length of ICU stay and hospitalization, and increased risk of hypotension with dexmedetomidine.

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

“…Surprisingly, our analysis did not found a difference in the incidence of delirium between the two groups of patients [ Figure 4-A]. 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 influenced the results.…”

“…Three main reasons prompted this investigation. First, we wanted to perform a further and more recent meta-analysis comparing dexmedetomidine and propofol, after similar previous publications [1,[30][31][32][33][34], to provide the reader with a more comprehensive statistical analysis of such a comparison.…”

“…To be more accurate, the comparison was limited RCTs and to those comparing dexmedetomidine and propofol only, in contrast with previous meta-analyses including comparisons between sedatives and placebo [32][33][34][35]. Second, studies conducted on an international level, rather than those limited to the United States, were included to provide the reader with a wider perspective, a higher external validity, and conclusions applicable to different healthcare systems.…”

“…However, any postoperative complication can delay the timing of extubation directly (e.g., prolonged ventilation) or indirectly (e.g., re-operation) and alter the value of these endpoints. Moreover, there is no consensus about the time of extubation after cardiac surgery, and the actual ventilation time that leads to complications is not known [32].…”

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

“…First, we wanted to perform a further and more recent meta-analysis comparing dexmedetomidine and propofol, after similar previous publications [1,[30][31][32][33][34], to provide the reader with a more comprehensive statistical analysis of such a comparison. To be more accurate, the comparison was limited RCTs and to those comparing dexmedetomidine and propofol only, in contrast with previous meta-analyses including comparisons between sedatives and placebo [32][33][34][35]. Second, studies conducted on an international level, rather than those limited to the United States, were included to provide the reader with a wider perspective, a higher external validity, and conclusions applicable to different healthcare systems.…”