Dexmedetomidine offers little for Afib, delirium after cardiac surgery

  • Turan A & al.
  • Lancet
  • 18 Jul 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Dexmedetomidine should not be infused to decrease postoperative Afib or delirium following cardiac surgery, say these authors, in part because delirium might even be worsened.
  • Their results from a randomized trial show no benefit with 24-hour infusion begun at anesthesia induction and risk for provoking hypotension.

Why this matters

  • Both Afib and delirium are problems associated with cardiac surgery, and dexmedetomidine’s sedative properties had been posited to reduce risk.

Key results

  • Afib incidence was 30% with drug vs 34% with placebo.
    • Relative risk (RR): 0.91 (97.8% CI, 0.72-1.15).
  • Delirium incidence was 17% with drug vs 12% with placebo.
    • RR: 1.48 (97.8% CI, 0.99-2.23).
  • 5% had a serious adverse event in the exposure group vs 2% with placebo.
  • 1 patient in each group died (
  • Patterns were similar in sensitivity analyses.
  • No effect on kidney injury/failure rates or 90-day pain was detected.
  • ICU stay was longer with dexmedetomidine.
  • Clinically important hypotension was more common with dexmedetomidine and associated with delirium.

Study design

  • Randomized, placebo-controlled multicenter trial, 6 US academic hospitals.
  • 398 patients in dexmedetomidine group vs 396 in placebo (saline); all undergoing cardiopulmonary bypass.
  • Dexmedetomidine: 0.1 μg/kg per hour increased to 0.2 μg/kg per hour at the end of bypass, then to 0.4 μg/kg per hour maintained to 24 hours.
  • Funding: Hospira Pharmaceuticals.

Limitations

  • Anesthetic management varied.
  • Relatively low dose of dexmedetomidine.