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