Dexmedetomidine prevents post-op delirium after noncardiac surgery

  • Zeng H & al.
  • PLoS ONE
  • 1 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In elderly patients who underwent non-cardiac surgery, the perioperative prophylactic use of dexmedetomidine was associated with lower occurrence of post-operative delirium (POD) than placebo.
  • Dexmedetomidine use reduced the occurrence of tachycardia, hypertension, stroke, and hypoxaemia was associated with an increased risk for bradycardia.

Why this matters

  • Findings suggest that perioperative intervention with dexmedetomidine may be a promising alternative for reducing the incidence of delirium following surgery.

Study design

  • Meta-analysis of 6 randomised controlled trials included 2102 elderly patients (age, ≥65 years) who underwent non-cardiac surgery.
  • Primary outcome: incidence of POD.
  • Funding: Guangzhou University of Chinese Medicine and others.

Key results

  • 15.2% events of POD were reported in 6 studies.
  • Dexmedetomidine vs placebo significantly reduced:
    • prevalence of POD (risk ratio [RR], 0.61; 95% CI, 0.34-0.76; P=.001; I2=66%),
    • risk of tachycardia (RR, 0.48; 95% CI, 0.30-0.76; P=.002; I2=0%),
    • hypertension (RR, 0.59; 95% CI, 0.44-0.79; P<.001 i>2=20%),
    • stroke (RR, 0.22; 95% CI, 0.06-0.76; P=.02; I2= 0%), and
    • hypoxaemia (RR, 0.50; 95% CI, 0.32-0.78; P=.002; I2=0%).
  • Patients with dexmedetomidine vs placebo had a higher risk for perioperative bradycardia (RR, 1.36; 95% CI, 1.11-1.67; P=.003; I2=0%).
  • No significant differences observed in the incidence of hypotension, myocardial infarction and all-cause mortality between both the groups.

Limitations

  • Limited number of studies included.
  • Heterogeneity among included studies.