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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Dexmedetomidine for delirium prevention after cardiac surgery: An updated systematic review and meta-analysis with
Lucas Caetano da Silva1, Vanessa Tapioca2, Patricia Viana3
1Department of Medicine, Federal University of Paraiba, Brazil.
Background:
Postoperative delirium remains a common complication after cardiac surgery. The impact of dexmedetomidine (DEX) on preventing postoperative delirium is still controversial as recent randomized controlled trials (RCTs) have presented conflicting results.
Methods:
We conducted an updated systematic review and meta-analysis of RCTs evaluating DEX efficacy in preventing delirium after cardiac surgery. A systematic search of MEDLINE, Embase, and Cochrane databases identified RCTs comparing DEX with placebo or other treatments in patients aged ≥18 years. Sensitivity, subgroup analyses, and trial sequential analysis (TSA) assessed the robustness of the findings.
Results:
A total of 31 RCTs including 5628 patients were analyzed, 50.1% of them receiving DEX. Delirium incidence was significantly lower in the DEX group (RR 0.61; 95% CI, 0.49-0.75; P < 0.001). This protective effect remained across subgroup analyses based on age, control type, delirium assessment method, and after excluding trials at high risk of bias. DEX use was associated with a shorter intensive care unit length of stay (MD -0.14 days; 95% CI, -1.28 to -0.04; P < 0.01). TSA confirmed the result's robustness. However, DEX increased bradycardia risk (RR 1.53; 95% CI, 1.05-2.21; P = 0.02). No significant differences were found in mortality, intubation duration, hospital length of stay, atrial fibrillation, or hypotension.
Conclusions:
Dexmedetomidine significantly reduces postoperative delirium following cardiac surgery, with moderate evidence confirmed by TSA. While it demonstrates clinical benefits, careful bradycardia monitoring is warranted.
Systematic Review Protocol:
PROSPERO (CRD42024593472).
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