A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery

Hb, Wang; Jia, Yuan; Zhang, C-B; Zhang, L; Li, Y-N; Ding, Jian; Wu, Xinhai; Zhang, Zheng; Jh, Wang; Wang, Y; Yan, F-X; Su, Yuan; Sessler, Daniel I.

doi:10.1111/anae.15983

Cited by 10 publications

(4 citation statements)

References 38 publications

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“…Our data may partially explain the findings of Wang et al., which showed an increased risk of postoperative AKI in patients undergoing cardiac surgery [9]; but the harm signal in this study was statistically fragile and seemed to be driven by stage 1 AKI, limiting clinical significance. In our study, we found no differences in renal macro‐ or microcirculatory perfusion or oxygenation that could explain the increased incidence and severity of histological renal tubular injury.…”

Section: Discussionsupporting

confidence: 57%

“…Intra-operative administration of the a 2 -agonist, dexmedetomidine, has been reported to reduce the incidence of both AKI and delirium following cardiac surgery [7]. However, larger prospective studies have cast doubt on these findings [8,9]. Consequently, the role of dexmedetomidine in preventing these complications following cardiac surgery remains uncertain [2,10].…”

Section: Introductionmentioning

confidence: 99%

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Effects of dexmedetomidine on kidney and brain tissue microcirculation and histology in ovine cardiopulmonary bypass: a randomised controlled trial

Jufar,

May,

Booth

et al. 2023

Anaesthesia

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SummaryCardiac surgery requiring cardiopulmonary bypass is associated with postoperative acute kidney injury and neurocognitive disorders, including delirium. Intra‐operative inflammation and/or impaired tissue perfusion/oxygenation are thought to be contributors to these outcomes. It has been hypothesised that these problems may be ameliorated by the highly selective α2‐agonist, dexmedetomidine. We tested the effects of dexmedetomidine on renal and cerebral microcirculatory tissue perfusion, oxygenation and histology in a clinically relevant ovine model. Sixteen sheep were studied while conscious, after induction of anaesthesia and during 2 h of cardiopulmonary bypass. Eight sheep were allocated randomly to receive an intravenous infusion of dexmedetomidine (0.4–0.8 μg.kg‐1.h‐1) from induction of anaesthesia to the end of cardiopulmonary bypass, and eight to receive an equivalent volume of matched placebo (0.9% sodium chloride). Commencement of cardiopulmonary bypass decreased renal medullary tissue oxygenation in the placebo group (mean (95%CI) 5.96 (4.24–7.23) to 1.56 (0.84–2.09) kPa, p = 0.001), with similar hypoxic levels observed in the dexmedetomidine group (6.33 (5.33–7.07) to 1.51 (0.33–2.39) kPa, p = 0.002). While no differences in kidney function (i.e. reduced creatinine clearance) were evident, a greater incidence of histological renal tubular injury was observed in sheep receiving dexmedetomidine (7/8 sheep) compared with placebo (2/8 sheep), p = 0.041. Graded on a semi‐quantitative scale (0–3), median (IQR [range]) severity of histological renal tubular injury was higher in the dexmedetomidine group compared with placebo (1.5 (1–2 [0–3]) vs. 0 (0–0.3 [0–1]) respectively, p = 0.013). There was no difference in cerebral tissue microglial activation (neuroinflammation) between the groups. Dexmedetomidine did not reduce renal medullary hypoxia or cerebral neuroinflammation in sheep undergoing cardiopulmonary bypass.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Effects of dexmedetomidine on kidney and brain tissue microcirculation and histology in ovine cardiopulmonary bypass: a randomised controlled trial

Jufar,

May,

Booth

et al. 2023

Anaesthesia

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“…Delirium will be evaluated only once on day 1 after surgery, and twice daily (08:00-12:00 and 18:00-20:00) from days 2-7 after surgery by an independent follow-up staff team who will be blinded to group assignment using the Richmond Agitation Sedation Scale (RASS), and the Confusion Assessment Method for ICU (CAM-ICU). [32][33][34] The sedation status will be first assessed through RASS with a score ranging from −5 to +4. When the RASS score ≥-3, delirium will be evaluated.…”

Section: Outcome Assessmentmentioning

confidence: 99%

Effect of percutaneous cerebral oximetry-guided anaesthetic management on postoperative delirium in older adults undergoing off-pump coronary artery bypass grafting: study protocol for a single-centre prospective randomised controlled trial in a tertiary academic hospital in China

Tian,

Wang,

Jia

et al. 2023

BMJ Open

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IntroductionPostoperative delirium is a prominent and clinically important complication in older adults after coronary artery bypass grafting (CABG) surgery, resulting in prolonged hospital stay, long-term cognitive impairment and increased morbidity and mortality. Many studies have shown that cerebral desaturation is associated with increased risk of postoperative delirium during on-pump cardiac surgery. However, few studies have focused on the effect of optimising regional cerebral oxygen saturation (rSO2) on postoperative delirium during off-pump CABG. The purpose of this study is to investigate whether intraoperative anaesthetic management based on percutaneous cerebral oximetry monitoring decreases the incidence of postoperative delirium in older adults undergoing off-pump CABG.MethodsThis single-centre randomised controlled trial will randomly assign 200 patients to the intervention group or the control group at a ratio of 1:1. The patients in the intervention group will be observed by percutaneous cerebral oximetry monitoring that the desaturation (a drop of more than 20% from baseline value or rSO2less than 55% for >60 consecutive seconds at either probe) during the procedure triggered the intervention strategies, while the cerebral oximetry data of the control group will be hidden from the clinical team and patients will be anaesthetised by the usual anaesthetic management. The primary outcome will be the incidence of postoperative delirium during the first 7 days after off-pump CABG. Delirium will be comprehensively evaluated by the combination of the Richmond Agitation Sedation Scale and the Confusion Assessment Method for the intensive care unit. The secondary outcomes will include the incidence of postoperative acute kidney injury and myocardial infarction during the hospital stay, as well as the intensive care unit and hospital length of stay.Ethics and disseminationThis study was approved by the Ethics Committee of the Chinese Academy of Medical Sciences, Fuwai Hospital (No 2022–1824). Written informed consent will be obtained from each patient or their legal representatives before enrolment. The results of this trial will be published in an international peer-reviewed scientific journal.Trial registration numberChiCTR2300068537.

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“…We read with interest the article by Wang et al which concluded that an intra-operative dexmedetomidine infusion did not decrease the incidence of delirium during the first 7 postoperative days in patients undergoing cardiac surgery, but might impair renal function, compared with placebo [1].…”

mentioning

confidence: 99%

Dexmedetomidine for delirium in adults undergoing heart valve surgery

Wang,

Chen,

2024

Anaesthesia

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A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery

Cited by 10 publications

References 38 publications

Effects of dexmedetomidine on kidney and brain tissue microcirculation and histology in ovine cardiopulmonary bypass: a randomised controlled trial

Effects of dexmedetomidine on kidney and brain tissue microcirculation and histology in ovine cardiopulmonary bypass: a randomised controlled trial

Effect of percutaneous cerebral oximetry-guided anaesthetic management on postoperative delirium in older adults undergoing off-pump coronary artery bypass grafting: study protocol for a single-centre prospective randomised controlled trial in a tertiary academic hospital in China

Dexmedetomidine for delirium in adults undergoing heart valve surgery

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