Delirium is an acute brain disorder that causes changes in consciousness, attention, cognition, and perception. The incidence of post-operative delirium is high in patients undergoing cardiac surgery, about 20-50%, and this risk increases in the elderly.
Post-operative delirium (POD) can lead to worsening outcomes, such as prolonged stay, morbidity, and mortality. Although the risk factors and consequences of POD can be well managed, there are no approved drugs for the treatment of POD. Meanwhile, the role of dexmedetomidine in preventing POD after cardiac surgery is controversial because several studies have shown negative results.
A meta-analysis was conducted to clarify the POD controversy over the use of dexmedetomidine. The method is to collect data from the PubMed database, Web of Science, Cochrane Library until August 2020. The research that met the criteria were 15 RCT studies with 2813 subjects. The results showed that dexmedetomidine can reduce the risk of POD in the population undergoing cardiac surgery (OR 0 .56, 95%CI 0.36–0.89, P = 0.0004, I2 = 64%).
Subgroup analysis showed that the protective effect of dexmedetomidine was seen only in patients who were injected with dexmedetomidine after surgery but not at the start of surgery, in adults without age restrictions but excluding the elderly, and in studies comparing other sedatives rather than placebo. There were no statistical differences in the secondary parameters, namely hypotension (OR 1.13; 95% CI 0.54–2.37, P < 0.00001, I2 = 85%), bradycardia (OR 1.72; 95% CI 0, 84–3.53, P = 0.04, I2 = 58%), and atrial fibrillation (OR 0.87; 95% CI 0.70–1.08, P = 0.43, I2 = 0).
The results of a meta-analysis involving 15 RCT studies (n=2813) showed that dexmedetomidine could reduce the incidence of POD compared to other sedatives and opioids in adult patients undergoing cardiac surgery.
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Reference:
1. Li P, Li L, Zhao Z, Xie J, Zhu C, Deng X, et al. dexmedetomidine reduces the incidence of post-operative delirium after cardiac surgery: a meta-analysis of randomized controlled trials. BMC Anesthesiology 2021;21:153.
2. Rudiger A, Begdeda H, Babic D, Kruger B, Seifert B, Schubert M, et al. Intraoperative events during cardiac surgery are risk factors for the development of delirium in the ICU. Crit Care. 2016;20:264.
