The Impact of Intraoperative Dexmedetomidine Infusion on Postoperative Delirium Prevention in Intensive Care Unit Patients after Esophagectomy: A Randomized Double-Blind Clinical Trial.

Background: Delirium is a significant issue for esophagectomy patients, with dexmedetomidine (Dex) showing promise in alleviating this burden. A randomized trial on Dex's role in post-esophagectomy delirium can enhance care strategies and patient outcomes.

Methods: This randomized, double-blind clinical trial, conducted at Imam Reza Hospital, Tabriz University of Medical Sciences, in Iran in 2022, involved 60 esophagectomy patients. The intervention group received Dex infusion (0.5 μg/kg/h), while the control group received normal saline. Postoperatively, patients received analgesia and were monitored for delirium incidence over 3 days in the intensive care unit (ICU) using the Confusion Assessment Method. This study utilized an independent-sample t test, the Mann-Whitney U test, the χ2 test, and the Kaplan-Meier survival analysis with a log-rank test for data comparisons.

Results: Delirium in the ICU over 3 days after surgery was significantly lower in the intervention group (10%, n=3) compared with the control group (20%, n=6) (relative risk, 0.62 [95% CI, 0.42-0.98]; P=0.036). On the first day, no delirium cases occurred in the intervention group, contrasting with 2 cases in the control group (P=0.014). Similarly, on the second day, one case was observed in the intervention group versus 2 in the control group (P=0.042). On the third day, 2 cases were recorded in the intervention group versus 3 in the control group (P=0.031).

Conclusion: The significant reduction in delirium occurrence observed in patients receiving intraoperative Dex infusion highlights its potential as a preventive strategy for postoperative delirium in ICU patients after esophagectomy.