Dexmedetomidine for delirium prevention in adult patients following cardiac surgery: a meta-analysis of randomized controlled trials.

Abstract

Objectives: To determine whether perioperative administration of dexmedetomidine reduces the incidence of postoperative delirium in adult patients undergoing cardiac surgery.

Methods: We searched the PubMed, Embase and Cochrane Library databases for randomized controlled trials from the last 10 years up to March 10, 2024. We then conducted a meta-analysis to evaluate the effectiveness and safety of dexmedetomidine in preventing delirium after cardiac surgery in adults. This meta-analysis followed the steps in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA2020) guidelines. This study is registered with INPLASY under number INPLASY202430132.

Results: A total of 2689 patients were included in our analyses. All included studies were randomized controlled trials. Dexmedetomidine can reduce the occurrence of delirium in patients after cardiac surgery(OR 0.75, 95%CI 0.57-0.98, I² = 12%, P = 0.04). In terms of other end events, length of intensive care unit(ICU) stay(MD -0.16, 95%CI -1.85-1.53, I² = 0%, P = 0.85) and mortality(OR 1.59, 95%CI 0.74-3.42, I² = 0%, P = 0.23) were not statistically different with dexmedetomidine compared with placebo. Bradycardia (OR 0.85, 95%CI 0.54 ~ 1.34, I² = 72%, P = 0.49) and hypotension (OR 1.97, 95%CI 0.96 ~ 4.03, I² = 84%, P = 0.06) were not significantly different between the two groups.

Conclusions: Dexmedetomidine is safe for cardiac surgery patients and to some extent reduces the incidence of delirium in cardiac surgery patients, which is more important in preoperative use.