Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery
2015/11/17 by George Djaiani, Natalie Silverton, Natalie A. Silverton +5 · 28 citations
Medicine · #Intensive Care Unit Cognitive Disorders #Anesthesia and Sedative Agents #Enhanced Recovery After Surgery
paper · doi:10.1097/aln.0000000000000951
Abstract
BACKGROUND: Postoperative delirium (POD) is a serious complication after cardiac surgery. Use of dexmedetomidine to prevent delirium is controversial. The authors hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD. METHODS: After institutional ethics review board approval, and informed consent, a single-blinded, prospective, randomized controlled trial was conducted in patients 60 yr or older undergoing cardiac surgery. Patients with a history of serious mental illness, delirium, and severe dementia were excluded. Upon admission to intensive care unit (ICU), patients received either dexmedetomidine (0.4 μg/kg bolus followed by 0.2 to 0.7 μg kg h infusion) or propofol (25 to 50 μg kg min infusion) according to a computer-generated randomization code in blocks of four. Assessment of delirium was performed with confusion assessment method for ICU or confusion assessment method after discharge from ICU at 12-h intervals during the 5 postoperative days. Primary outcome was the incidence of POD. RESULTS: POD was present in 16 of 91 (17.5%) and 29 of 92 (31.5%) patients in dexmedetomidine and propofol groups, respectively (odds ratio, 0.46; 95% CI, 0.23 to 0.92; P = 0.028). Median onset of POD was on postoperative day 2 (1 to 4 days) versus 1 (1 to 4 days), P = 0.027, and duration of POD 2 days (1 to 4 days) versus 3 days (1 to 5 days), P = 0.04, in dexmedetomidine and propofol groups, respectively. CONCLUSIONS: When compared with propofol, dexmedetomidine sedation reduced incidence, delayed onset, and shortened duration of POD in elderly patients after cardiac surgery. The absolute risk reduction for POD was 14%, with a number needed to treat of 7.1.
Cited by
- Effect of peri‐operative pharmacological interventions on postoperative delirium in patients having cardiac surgery: a systematic review and Bayesian network meta‐analysis
- Mapping Theme Trends and Research Frontiers in Dexmedetomidine Over Past Decade: A Bibliometric Analysis
- A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
- Frailty, Aging, and Cardiovascular Surgery. [europepmc]
- Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment. [europepmc]
- Perioperative cognitive protection. [europepmc]
- Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: A randomized controlled trial. [europepmc]
- Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial. [europepmc]
- Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial. [europepmc]
- Delirium in Older Persons: Advances in Diagnosis and Treatment. [europepmc]
- Intensive Care Unit Delirium and Intensive Care Unit-Related Posttraumatic Stress Disorder. [europepmc]
- Dexmedetomidine prevents acute kidney injury after adult cardiac surgery: a meta-analysis of randomized controlled trials. [europepmc]
- Inflammatory markers in postoperative delirium (POD) and cognitive dysfunction (POCD): A meta-analysis of observational studies. [europepmc]
- Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis. [europepmc]
- Effects of propofol, dexmedetomidine, and midazolam on postoperative cognitive dysfunction in elderly patients: a randomized controlled preliminary trial. [europepmc]
- Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. [europepmc]
- Dexmedetomidine: present and future directions. [europepmc]
- Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis. [europepmc]
- Impact of postoperative dexmedetomidine infusion on incidence of delirium in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial. [europepmc]
- Intraoperative Oxidative Damage and Delirium after Cardiac Surgery. [europepmc]
- American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. [europepmc]
- Dexmedetomidine and Clonidine Attenuate Sevoflurane-Induced Tau Phosphorylation and Cognitive Impairment in Young Mice via α-2 Adrenergic Receptor. [europepmc]
- Safety and Efficacy of Dexmedetomidine in Acutely Ill Adults Requiring Noninvasive Ventilation: A Systematic Review and Meta-analysis of Randomized Trials. [europepmc]
- Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis. [europepmc]
- Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis. [europepmc]
- Effect of Intraoperative Dexmedetomidine on Recovery of Gastrointestinal Function After Abdominal Surgery in Older Adults: A Randomized Clinical Trial. [europepmc]
- Recent Advances in the Clinical Value and Potential of Dexmedetomidine. [europepmc]
- Effects of inflammation and oxidative stress on postoperative delirium in cardiac surgery. [europepmc]
Related