X Duan1, M Coburn2, R Rossaint3, R D Sanders4, J V Waesberghe3, A Kowark3. 1. Department of Anaesthesiology, The Affiliated Hospital of Southwest Medical University, LuZhou, China; Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany. 2. Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany. Electronic address: mcoburn@ukaachen.de. 3. Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany. 4. Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Abstract
BACKGROUND: The influence of dexmedetomidine on postoperative delirium (POD) in adult surgical patients remains controversial. We aimed to analyse whether dexmedetomidine use could decrease POD incidence in this population and its relation to timing of dexmedetomidine administration and patient age. METHODS: We used random-effects modelled meta-analysis, trial sequential analysis, and followed Cochrane methodology with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). PubMed and Cochrane library were searched up to July 2017 for randomised controlled trials that analysed POD incidence of adult surgical patients (age ≥18 yr) after dexmedetomidine administration. RESULTS: Eighteen studies (comprising 3309 patients) were included. There was decreased risk of POD with dexmedetomidine use for the entire adult surgical population [odds ratio (OR) 0.35; 95% confidence interval (CI) 0.24-0.51)], with firm evidence from trial sequential analysis. Pre-specified subgroup analyses confirmed this result with firm evidence for cardiac and non-cardiac surgical patients, (OR 0.41; 95% CI 0.26-0.63) and (OR 0.33; 95% CI 0.18-0.59), respectively. We also found firm evidence for reduction of POD if dexmedetomidine is administered during the postoperative period (OR 0.30; 95% CI 0.21-0.44), in patients aged <65 yr (OR 0.19; 95% CI 0.10-0.36) or ≥65 yr (OR 0.44; 95% CI 0.30-0.65). Evidence for dexmedetomidine's influence on secondary outcomes (in-hospital mortality, intensive care unit and hospital length of stay, bradycardia, and hypotension) is thus far insufficient to draw conclusions. CONCLUSION: Dexmedetomidine can reduce POD incidence for adult cardiac and non-cardiac surgical patients. The optimal dose and timing of dexmedetomidine and influence on other outcomes or particular patient populations with risk factors warrants further studies. CLINICAL TRIAL REGISTRATION: PROSPERO: CRD42017072380.
BACKGROUND: The influence of dexmedetomidine on postoperative delirium (POD) in adult surgical patients remains controversial. We aimed to analyse whether dexmedetomidine use could decrease POD incidence in this population and its relation to timing of dexmedetomidine administration and patient age. METHODS: We used random-effects modelled meta-analysis, trial sequential analysis, and followed Cochrane methodology with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). PubMed and Cochrane library were searched up to July 2017 for randomised controlled trials that analysed POD incidence of adult surgical patients (age ≥18 yr) after dexmedetomidine administration. RESULTS: Eighteen studies (comprising 3309 patients) were included. There was decreased risk of POD with dexmedetomidine use for the entire adult surgical population [odds ratio (OR) 0.35; 95% confidence interval (CI) 0.24-0.51)], with firm evidence from trial sequential analysis. Pre-specified subgroup analyses confirmed this result with firm evidence for cardiac and non-cardiac surgical patients, (OR 0.41; 95% CI 0.26-0.63) and (OR 0.33; 95% CI 0.18-0.59), respectively. We also found firm evidence for reduction of POD if dexmedetomidine is administered during the postoperative period (OR 0.30; 95% CI 0.21-0.44), in patients aged <65 yr (OR 0.19; 95% CI 0.10-0.36) or ≥65 yr (OR 0.44; 95% CI 0.30-0.65). Evidence for dexmedetomidine's influence on secondary outcomes (in-hospital mortality, intensive care unit and hospital length of stay, bradycardia, and hypotension) is thus far insufficient to draw conclusions. CONCLUSION:Dexmedetomidine can reduce POD incidence for adult cardiac and non-cardiac surgical patients. The optimal dose and timing of dexmedetomidine and influence on other outcomes or particular patient populations with risk factors warrants further studies. CLINICAL TRIAL REGISTRATION: PROSPERO: CRD42017072380.
Authors: Elizabeth Mahanna-Gabrielli; Katie J Schenning; Lars I Eriksson; Jeffrey N Browndyke; Clinton B Wright; Deborah J Culley; Lis Evered; David A Scott; Nae Yah Wang; Charles H Brown; Esther Oh; Patrick Purdon; Sharon Inouye; Miles Berger; Robert A Whittington; Catherine C Price; Stacie Deiner Journal: Br J Anaesth Date: 2019-08-19 Impact factor: 9.166
Authors: Fayez Alshamsi; Kallirroi Laiya Carayannopoulos; Anders Granholm; Joshua Piticaru; Kimberley Lewis; Zainab Al Duhailib; Dipayan Chaudhuri; Laura Spatafora; Yuhong Yuan; John Centofanti; Jessica Spence; Bram Rochwerg; Dan Perri; Dale M Needham; Anne Holbrook; John W Devlin; Osamu Nishida; Kimia Honarmand; Begüm Ergan; Eugenia Khorochkov; Pratik Pandharipande; Mohammed Alshahrani; Tim Karachi; Mark Soth; Yahya Shehabi; Morten Hylander Møller; Waleed Alhazzani Journal: Intensive Care Med Date: 2022-06-01 Impact factor: 41.787