Dexmedetomidine for adult cardiac surgery: a systematic review, meta‐analysis and trial sequential analysis

Abstract

The effects of dexmedetomidine in adults undergoing cardiac surgery are inconsistent. We conducted a systematic review and meta-analysis to analyse the effects of peri-operative dexmedetomidine in adults undergoing cardiac surgery. We searched MEDLINE via Pubmed, EMBASE, Scopus and Cochrane for relevant randomised controlled trials between 1 January 1990 and 1 March 2022. We used the Joanna Briggs Institute methodology checklist to assess study quality and the GRADE approach to certainty of evidence. We assessed the sensitivity of results to false data. We used random-effects meta-analyses to analyse the primary outcomes: durations of intensive care and tracheal intubation. We included 48 trials of 6273 participants. Dexmedetomidine reduced the mean (95%CI) duration of intensive care by 5.0 (2.2-7.7) h, p = 0.001, and tracheal intubation by 1.6 (0.6-2.7) h, p = 0.003. The relative risk (95%CI) for postoperative delirium was 0.58 (0.43-0.78), p = 0.001; 0.76 (0.61-0.95) for atrial fibrillation, p = 0.015; and 0.49 (0.25-0.97) for short-term mortality, p = 0.041. Bradycardia and hypotension were not significantly affected. Trial sequential analysis was consistent with the primary meta-analysis. Adjustments for possible false data reduced the mean (95%CI) reduction in duration of intensive care and tracheal intubation by dexmedetomidine to 3.6 (1.8-5.4) h and 0.8 (0.2-1.4) h, respectively. Binary adjustment for methodological quality at a Joanna Briggs Institute score threshold of 10 did not alter the results significantly. In summary, peri-operative dexmedetomidine reduced the durations of intensive care and tracheal intubation and the incidence of short-term mortality after adult cardiac surgery. The reductions in intensive care stay and tracheal intubation may or may not be considered clinically useful, particularly after adjustment for possible false data.

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and CICU length of stay after heart valve surgery

“…Han, Y et al found that intraoperative application of a loading dose of dexamethasone combined with propofol during maintenance of anesthesia reduced heart rate and thus oxygen consumption by cardiac myocytes[28]. In addition, several studies have reported that perioperative use of dexmedetomidine reduced the duration of intensive care and tracheal intubation and the incidence of short-term mortality after cardiac surgery in adults [11,12,29,30]. In our study, we also found that dexmedetomidine as an anesthetic adjuvant was associated with a reduced incidence of major postoperative complications and a reduced cicu stay.…”

“…Dexmedetomidine is a potent, highly selective alpha-2 adrenoceptor agonist with sedative, analgesic, anxiolytic, anti-sympathetic and opioid-sparing properties [4,5].A number of studies have shown that dexmedetomidine is a useful adjunct to cardiac anesthesia [6,7] .Dexmedetomidine acts as an anesthetic adjuvant, reducing the need for opioids, inhalation anesthetics and intravenous anesthetics [8], and its anti-sympathetic activity reduces myocardial oxygen consumption by decreasing metabolism and preventing tachycardia, thereby reducing the incidence of postoperative complications in cardiac surgery, including myocardial ischemia [8,9] .Therefore, in addition to investigating the more de nitive endpoint of myocardial injury/infarction, this study examined the potential impact of dexmedetomidine on other primary endpoints, such as cardiac arrest during the postoperative period in patients undergoing cardiac surgery, congestive heart failure (CHF), and atrial brillation. Several studies have reported a reduction in cicu residence time with perioperative dexmedetomidine [10][11][12] ,suggesting that dexmedetomidine may promote rapid recovery of cardiac function in patients [12], but it is unknown whether the use of dexmedetomidine during maintenance of anesthesia for cardiac surgery has such an effect. Therefore, the speci c aim of this study was to assess whether the intraoperative use of dexmedetomidine as an anesthetic adjuvant was associated with a reduced CICU length of stay and a lower rate of major postoperative complications in patients undergoing heart valve surgery.…”

Effects and side‐effects of tranexamic acid: they both matter

“…Tsan et al. present the results of their systematic review, meta‐analysis and trial sequential analysis examining the link between tranexamic acid and thromboembolism in non‐cardiac surgery [10]. They included 191 randomised controlled trials with over 40,000 patients.…”

“…We can examine in further detail the methodology used by Tsan et al. [10]. Anaesthesia has defined standards for the performing and reporting of meta‐analyses [11, 12] and identified critical steps that are recommended for consideration both to readers and to authors of meta‐analyses alike.…”

“…General guidance for a meta‐analysis is given by the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) statement [13] and this guidance was also followed by Tsan et al. [10].…”