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Meta-Analysis
. 2021 May 18;21(1):153.
doi: 10.1186/s12871-021-01370-1.

Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: a meta-analysis of randomized controlled trials

Peng Li #  1 , Lu-Xi Li #  1 , Zhen-Zhen Zhao  1 , Jian Xie  1 , Cheng-Long Zhu  1 , Xiao-Ming Deng  2 , Jia-Feng Wang  3
Affiliations
Meta-Analysis

Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: a meta-analysis of randomized controlled trials

Peng Li et al. BMC Anesthesiol. .

Abstract

Background: The role of dexmedetomidine in preventing postoperative delirium (POD) after cardiac surgery remains controversial because of several recent trials with negative results. We aimed to perform an updated meta-analysis of randomized controlled trials (RCTs) to clarify this controversy.

Methods: RCTs investigating the perioperative administration of dexmedetomidine in cardiac surgery were retrieved from PubMed, Web of Science, and the Cochrane library until August,27,2020. Two researchers independently screened the literature, collected the data and evaluated the bias risk of the included studies. The meta-analysis was performed with the RevMan 5.3.

Results: A total of 15 studies including 2813 patients were included in the study. A pooled result showed that dexmedetomidine could reduce the risk of POD in adult population underwent cardiac surgery (OR 0.56, 95%CI 0.36-0.89, P = 0.0004, I2 = 64%). The subgroup analysis demonstrated that the protective effect of dexmedetomidine was only present in the patients injected with dexmedetomidine after surgery but not from the start of surgery, in the adult patients without specific age limitation but not in the elderly, and in the studies in comparison with other sedatives but not with placebo. There were no statistical differences when analyzing the secondary outcomes including hypotension (OR 1.13; 95% CI 0.54-2.37, P < 0.00001, I2 = 85%), bradycardia (OR 1.72; 95% CI 0.84-3.53, P = 0.04, I2 = 58%) and atrial fibrillation (OR 0.87; 95% CI 0.70-1.08, P = 0.43, I2 = 0).

Conclusions: Dexmedetomidine can reduce the incidence of POD compared to other sedatives and opioids after cardiac surgery in adult patients. The proper population and timing for perioperative use of dexmedetomidine after cardiac surgery remain to be further investigated.

Keywords: Cardiac surgery; Dexmedetomidine; Postoperative delirium.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram following the PRISMA guideline
Fig. 2
Fig. 2
The risk of bias assessment of each included trial according to the Cochrane Risk of Bias Methods
Fig. 3
Fig. 3
The forest plot of postoperative delirium incidence
Fig. 4
Fig. 4
The Funnel plot of postoperative delirium incidence
Fig. 5
Fig. 5
Subgroup analysis of postoperative delirium incidence within different age subgroups
Fig. 6
Fig. 6
Subgroup analysis of postoperative delirium incidence within different administration time-point
Fig. 7
Fig. 7
Subgroup analysis of postoperative delirium incidence within different controls
Fig. 8
Fig. 8
The forest plot of postoperative hypotension incidence
Fig. 9
Fig. 9
The forest plot of postoperative bradycardia incidence
Fig. 10
Fig. 10
The forest plot of postoperative atrial fibrillation incidence
See this image and copyright information in PMC

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