Dexmedetomidine in Cardiac Surgery Patients Who Fail Extubation and Present with a Delirium State

Yapıcı, Nihan; Çoruh, Türkan; Kehlіbar, Tamer; Yapıcı, Fikri; Tarhan, Arif; Can, Yeşim; Özler, Azmi; Aykaç, Zuhal

doi:10.1532/hsf98.201011102

Cited by 39 publications

(54 citation statements)

References 14 publications

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“…Twenty-seven articles were excluded because 20 investigated sedation protocol that the type of sedative drugs could not be identified, 4 studies were secondary analysis of previous reports, and 3 were study protocols. As a result, a total of 51 citations comprising 52 RCTs were included in our analysis141516171819202122232425262728293031323334353637383940414243444546474849505152535455565758596061626364. The article by Jakob and colleagues comprised two RCTs38.…”

Section: Resultsmentioning

confidence: 99%

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Zhang

Chen

et al. 2017

Sci Rep

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Sedatives are commonly used for mechanically ventilated patients in intensive care units (ICU). However, a variety of sedatives are available and their efficacy and safety have been compared in numerous trials with inconsistent results. To resolve uncertainties regarding usefulness of these sedatives, we performed a systematic review and network meta-analysis. Randomized controlled trials comparing sedatives in mechanically ventilated ICU patients were included. Graph-theoretical methods were employed for network meta-analysis. A total of 51 citations comprising 52 RCTs were included in our analysis. Dexmedetomidine showed shorter MV duration than lorazepam (mean difference (MD): 68.7; 95% CI: 18.2–119.3 hours), midazolam (MD: 10.2; 95% CI: 7.7–12.7 hours) and propofol (MD: 3.4; 95% CI: 0.9–5.9 hours). Compared with dexmedetomidine, midazolam was associated with significantly increased risk of delirium (OR: 2.47; 95% CI: 1.17–5.19). Our study shows that dexmedetomidine has potential benefits in reducing duration of MV and lowering the risk of delirium.

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Section: Resultsmentioning

confidence: 99%

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Zhang

Chen

et al. 2017

Sci Rep

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“…), whereas the largest study included 10,352 patients (Dasta, et al .). Eight studies compared dexmedetomidine with alternative hypnotic agents (seven studies with propofol [12-18], three with midazolam [16,17,19], and one with lorazepam [17]). Two studies compared dexmedetomidine with morphine [11,20].…”

Section: Resultsmentioning

confidence: 99%

“…[14] found no difference in the incidence of myocardial infarction ( P = 0.371) and cardiac failure ( P = 0.723) between dexmedetomidine and propofol, and Yapici et al . [19] and Shehabi et al . [20] reported similar incidence of postoperative low output syndrome ( P = 0.093) and cardiac arrest ( P = 0.513), respectively.…”

Section: Resultsmentioning

confidence: 99%

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Lin

Chen

et al. 2012

Crit Care

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IntroductionThe aim of this study was to explore the use of dexmedetomidine as a safe and efficacious sedative agent in post-cardiac surgery patients.MethodsA systematic literature search of MEDLINE, EMBASE, the Cochrane Library and Science Citation Index until January 2012 and review of studies was conducted. Eligible studies were of randomized controlled trials or cohort studies, comparing dexmedetomidine with a placebo or an alternative sedative agent in elective cardiac surgery, using dexmedetomidine for postoperative sedation and available in full text. Two reviewers independently performed study selection, quality assessment, and data extraction.ResultsThe search identified 530 potentially relevant publications; 11 met selection criteria in this meta-analysis. Our results revealed that dexmedetomidine was associated with a shorter length of mechanical ventilation (mean difference -2.70 [-5.05, -0.35]), a lower risk of delirium (risk ratio 0.36 [0.21, 0.64]), ventricular tachycardia (risk ratio 0.27 [0.08, 0.97]) and hyperglycemia (risk ratio 0.78 [0.61, 0.99]), but may increase the risk of bradycardia (risk ratio 2.08 [1.16, 3.74]). But there was no significant difference in ICU stay, hospital stay, and morphine equivalents between the included studies. Dexmedetomidine may not increase the risk of hypotension, atrial fibrillation, postoperative nausea and vomiting, reintubation within 5 days, cardiovascular complications, postoperative infection or hospital mortality.ConclusionsDexmedetomidine was associated with shorter length of mechanical ventilation and lower risk of delirium following cardiac surgery. Although the risk of bradycardia was significantly higher compared with traditional sedatives, it may not increase length of hospital stay and hospital mortality. Moreover, dexmedetomidine may decrease the risk of ventricular tachycardia and hyperglycemia. Thus, dexmedetomidine could be a safe and efficacious sedative agent in cardiac surgical patients.

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“…Dexmedetomidine, a highly selective α 2 -adrenoceptor agonist, has been widely used as a sedative agent in the patients after surgery because it has many desirable properties for this use: its effects are not limited to sedation but also include antianxiety, analgesia, and inhibition on the activity of sympathetic nervous system [1][2][3]. In addition, dexmedetomidine does not depress respiratory drive [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effects of mild hypoalbuminemia on the pharmacokinetics and pharmacodynamics of dexmedetomidine in patients after major abdominal or thoracic surgery

Zhang

Deng

et al. 2015

Journal of Clinical Anesthesia

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Dexmedetomidine in Cardiac Surgery Patients Who Fail Extubation and Present with a Delirium State

Abstract: Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery.

Cited by 39 publications

References 14 publications

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Effects of mild hypoalbuminemia on the pharmacokinetics and pharmacodynamics of dexmedetomidine in patients after major abdominal or thoracic surgery

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