Effect of Perioperative Low-Dose Dexmedetomidine on Postoperative Delirium After Living-Donor Liver Transplantation: A Randomized Controlled Trial

Lee, Hannah; Yang, Seung Min; Chung, Jin-Gyun; Oh, Hye Won; Yi, Nam Joon; Suh, Kyung Suk; Oh, Seung Young; Ryu, Ho Geol

doi:10.1016/j.transproceed.2019.11.015

Cited by 24 publications

(39 citation statements)

References 26 publications

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“…We did not observe any adverse effect. This result may be related to our administrating the dexmedetomidine infusions without a loading dose, similar to the previous literature 13 …”

Section: Discussionsupporting

confidence: 90%

“…Postoperative delirium is a common clinical diagnosis in the solid organ transplant population associated with increased morbidity and prolonged length of hospital stay 10 . It has been shown in previous studies that delirium and agitation rates decreased in the ICU when dexmedetomidine was used 11‐13 . The patients receiving dexmedetomidine infusion had a significantly lower VAS score and did not need any opioid.…”

Section: Discussionmentioning

confidence: 99%

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Early extubation after liver transplantation: Is dexmedetomidine a good option?: A retrospective cohort study

et al. 2021

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Background Dexmedetomidine is a potent and highly selective alpha‐2 adrenoceptor agonist with sympatholytic, sedative, anxiolytic and analgesic properties. The aim of this study is to determine the effect of a dexmedetomidine infusion in liver transplant recipients in the early postoperative period on early and smooth extubation. Methods We performed a retrospective chart review of 21 patients undergoing liver transplantation between December 1, 2018 and February 31, 2020. Patients were divided into the dexmedetomidine and midazolam groups. The primary outcome was the extubation time. Secondary outcomes were mean arterial pressure and heart rate before and after extubation. The collected data included the patients’ age, gender, surgery time, Model for End‐stage Liver Disease score, cold ischemia time, blood transfusion amount and extubation visual analogue scale (VAS) scores. Results Extubation time was significantly shorter in the dexmedetomidine group than in the midazolam group (median [minimum‐maximum], 4 [0‐6], 8 [4‐13] hours, respectively, P = .000). Extubation VAS scores were statistically significantly lower in dexmedetomidine group (P = .000). Mean arterial pressure values before and after extubation were significantly higher in patients' midazolam group than the dexmedetomidine group (P = .003, P = .005, respectively). Conclusions Dexmedetomidine infusions provided early and smooth extubation with stable haemodynamics in our patients.

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“…We did not observe any adverse effect. This result may be related to our administrating the dexmedetomidine infusions without a loading dose, similar to the previous literature 13 …”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Early extubation after liver transplantation: Is dexmedetomidine a good option?: A retrospective cohort study

et al. 2021

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“…The other subgroup analyses were added during the manuscript revision process. First, we performed a subgroup analyses of cardiac 10 , 18 , 44 – 69 and non-cardiac surgery 5 – 9 , 16 , 17 , 21 , 22 , 70 – 116 . Second, we conducted a subgroup analysis for the studies which used CAM or CAM-ICU 6 , 9 , 10 , 17 , 18 , 21 , 22 , 48 , 49 , 51 – 53 , 55 , 57 , 59 , 61 , 62 , 65 , 66 , 69 , 70 , 74 – 80 , 83 – 85 , 88 , 89 , 92 – 102 , 106 , 107 , 115 , 117 .…”

Section: Methodsmentioning

confidence: 99%

“…First, we performed a subgroup analyses of cardiac 10 , 18 , 44 – 69 and non-cardiac surgery 5 – 9 , 16 , 17 , 21 , 22 , 70 – 116 . Second, we conducted a subgroup analysis for the studies which used CAM or CAM-ICU 6 , 9 , 10 , 17 , 18 , 21 , 22 , 48 , 49 , 51 – 53 , 55 , 57 , 59 , 61 , 62 , 65 , 66 , 69 , 70 , 74 – 80 , 83 – 85 , 88 , 89 , 92 – 102 , 106 , 107 , 115 , 117 . Third, we also performed a subgroup analysis for the studies which enrolled only old patients with age more than 70 years 5 – 10 , 17 , 18 , 22 , 55 , 57 , 59 , 66 , 72 , 73 , 77 – 80 , 85 , 88 , 93 , 94 , 97 , 98 , 101 , 102 , …”

Section: Methodsmentioning

confidence: 99%

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Park

Lim

Cho

et al. 2021

Sci Rep

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Many pharmacologic agents were investigated for the effect to prevent delirium. We aimed to comprehensively compare the effect of the pharmacological interventions to prevent postoperative delirium. A Bayesian network meta-analysis of randomized trials was performed using random effects model. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched on 20 January 2021. Randomized trials comparing the effect of a drug to prevent postoperative delirium with another drug or placebo in adult patients undergoing any kind of surgery were included. Primary outcome was the postoperative incidence of delirium. Eighty-six trials with 26,992 participants were included. Dexmedetomidine, haloperidol, and atypical antipsychotics significantly decreased the incidence of delirium than placebo [dexmedetomidine: odds ratio 0.51, 95% credible interval (CrI) 0.40–0.66, moderate quality of evidence (QOE); haloperidol: odds ratio 0.59, 95% CrI 0.37–0.95, moderate QOE; atypical antipsychotics: odds ratio 0.27, 95% CrI 0.14–0.51, moderate QOE]. Dexmedetomidine and atypical antipsychotics had the highest-ranking probabilities to be the best. However, significant heterogeneity regarding diagnostic time window as well as small study effects precludes firm conclusion.

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“…Potential adverse effects include bradycardia, hypertension, hypotension, elevated blood glucose, decreased serum potassium concentration, interaction with tacrolimus, and drug accumulation [ 6 , 35 – 37 ]. Although there were concerns of potential risks of delayed awakening and extubation due to the accumulation of DEX in patients with impaired liver function, no studies [ 9 , 38 ], including ours, have demonstrated any increase in the durations of mechanical ventilation, ICU stay, and hospital stay. This could be because the infusion rate and total dose of DEX in our study were lower than those of previous reports [ 9 , 27 , 28 , 35 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 73%

Intraoperative Low-Dose Dexmedetomidine Administration Associated with Reduced Hepatic Ischemia-Reperfusion Injury in Pediatric Deceased Liver Transplantation: A Retrospective Cohort Study

Zhang

Cui

et al. 2021

Ann Transplant

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Background Dexmedetomidine (DEX) attenuates hepatic ischemia-reperfusion injury (HIRI) in adult liver transplantation (LT), but its effects on postoperative liver graft function in pediatric LT remain unclear. We sought to investigate whether intraoperative DEX administration was associated with improved liver graft function in pediatric LT recipients. It was hypothesized that DEX administration was associated with reduced HIRI and improved liver graft function. Material/Methods From November 2015 to May 2020, 54 deceased pediatric LT recipients were categorized into a control group and a DEX group. Intraoperatively, the DEX group received an additional infusion of DEX at 0.4 μg/kg/h from incision to the end of the operation in comparison with the control group. Preoperative, intraoperative, and postoperative data were reviewed. Postoperative liver enzyme levels and HIRI severity were assessed and compared. Independent risk factors for HIRI were determined by multivariate logistic regression analysis using a stepwise forward conditional method. Results We enrolled 28 and 26 patients in the DEX and control groups, respectively. Patients in the DEX group exhibited a reduced incidence of moderate-to-severe HIRI (88.5% vs 60.7%, P =0.020) and decreased level of serum alanine aminotransferase (median [interquartile range]: 407 [230–826] vs 714 [527–1492] IU/L, P =0.048) compared with the controls. Binary logistic analysis revealed that longer cold ischemia time (odds ratio [OR]=1.006; 95% confidence interval [CI]=1.000–1.013; P =0.044) and intraoperative DEX use (OR=0.198; 95% CI=0.045–0.878; P =0.033) were independent predictors for moderate-to-severe HIRI. Conclusions Intraoperative low-dose DEX administration was associated with a lower incidence of moderate-to-severe HIRI in pediatric deceased LT. However, further studies are needed to confirm our results and elucidate the underlying mechanisms.

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Effect of Perioperative Low-Dose Dexmedetomidine on Postoperative Delirium After Living-Donor Liver Transplantation: A Randomized Controlled Trial

Cited by 24 publications

References 26 publications

Early extubation after liver transplantation: Is dexmedetomidine a good option?: A retrospective cohort study

Early extubation after liver transplantation: Is dexmedetomidine a good option?: A retrospective cohort study

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Intraoperative Low-Dose Dexmedetomidine Administration Associated with Reduced Hepatic Ischemia-Reperfusion Injury in Pediatric Deceased Liver Transplantation: A Retrospective Cohort Study

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