Influence of perioperative dexmedetomidine on the incidence of postoperative delirium in adult patients undergoing cardiac surgery

Patel, Mitul; Onwochei, Desire N.; Desai, Neel

doi:10.1016/j.bja.2021.11.041

Cited by 42 publications

(30 citation statements)

References 57 publications

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“…Two randomized controlled trials compared the effect of dexmedetomidine to midazolam and clonidine respectively, and both found that dexmedetomidine was more effective in the prevention of POD in patients who underwent stomatological or cardiovascular surgeries ( Shokri and Ali, 2020 ; Wang et al, 2020 ). However, in a 2022 meta-analysis of 30 RCTs comprising 4,090 patients ( Patel et al, 2022 ), perioperative dexmedetomidine administration failed to reduce the incidence of delirium in patients after cardiac surgeries. The possible explanation is that this meta-analysis included an increased number of trials, many of which have been published relatively recently and have not shown a beneficial relationship between dexmedetomidine and POD, and this study excluded trials at high risk of bias.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Postoperative delirium in geriatric patients with hip fractures

Chen

Liang

et al. 2022

Front. Aging Neurosci.

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Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.

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Section: Prevention and Treatmentmentioning

confidence: 99%

Postoperative delirium in geriatric patients with hip fractures

Chen

Liang

et al. 2022

Front. Aging Neurosci.

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“…Therefore, our model attempted to predict POD in a more general surgical population using a large dataset. Previous studies have shown that cardiac surgery and neurosurgery have a high incidence of POD, ranging from 16.2% to 32.4% 33 , 34 . Early risk stratification and intervention have become the standard of care for such patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of logistic regression and machine learning methods for predicting postoperative delirium in elderly patients: A retrospective study

et al. 2022

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Aims:To compare the performance of logistic regression and machine learning methods in predicting postoperative delirium (POD) in elderly patients. Method:This was a retrospective study of perioperative medical data from patients undergoing non-cardiac and non-neurology surgery over 65 years old from January 2014 to August 2019. Forty-six perioperative variables were used to predict POD.A traditional logistic regression and five machine learning models (Random Forest, GBM, AdaBoost, XGBoost, and a stacking ensemble model) were compared by the area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, and precision. Results:In total, 29,756 patients were enrolled, and the incidence of POD was 3.22% after variable screening. AUCs were 0.783 (0.765-0.8) for the logistic regression method, 0.78 for random forest, 0.76 for GBM, 0.74 for AdaBoost, 0.73 for XGBoost, and 0.77 for the stacking ensemble model. The respective sensitivities for the 6 aforementioned models were 74.

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“…(c) In contrast to dexmedetomidine, which requires a doctor's prescription, melatonin is sold as an over-the-counter drug, such as in the United States and China. (d) Multiple randomized controlled trials (RCTs) have demonstrated that the administration of dexmedetomidine is associated with a lower incidence of POD following non-cardiac surgery ( 39 – 41 ), however, dexmedetomidine was not associated with decreased incidence of POD following cardiac surgery ( 42 , 43 ). The different pharmacological mechanisms of dexmedetomidine and melatonin may lead to different effects of dexmedetomidine on POD.…”

Section: Discussionmentioning

confidence: 99%

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

Han

Tian

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe effectiveness of melatonin and its analogs in preventing postoperative delirium (POD) following cardiac surgery is controversial. The purpose of this systematic review and meta-analysis was to confirm the benefits of melatonin and its analogs on delirium prevention in adults who underwent cardiac surgery.MethodsWe systematically searched the PubMed, Cochrane Library, Web of Science, Embase, and EBSCOhost databases, the last search was performed in October 2021 and repeated before publication. The controlled studies were included if investigated the impact of melatonin and its analogs on POD in adults who underwent cardiac surgery. The primary outcome was the incidence of delirium. The Stata statistical software 17.0 was used to perform this study.ResultsThis meta-analysis included eight randomized controlled trials (RCTs) and two cohort studies with a total of 1,714 patients. The results showed that melatonin and ramelteon administration were associated with a significantly lower incidence of POD in adults who underwent cardiac surgery (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.29–0.74; P = 0.001). The subgroup analyses confirmed that melatonin 3 mg (OR, 0.37; 95% CI, 0.18–0.76; P = 0.007) and 5 mg (OR, 0.34; 95% CI, 0.21–0.56; P < 0.001) significantly reduced the incidence of POD.ConclusionMelatonin at dosages of 5 and 3 mg considerably decreased the risk of delirium in adults who underwent cardiac surgery, according to our results. Cautious interpretation of our results is important owing to the modest number of studies included in this meta-analysis and the heterogeneity among them.Systematic Review RegistrationPROSPERO registration number: CRD42021246984.

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Influence of perioperative dexmedetomidine on the incidence of postoperative delirium in adult patients undergoing cardiac surgery

Cited by 42 publications

References 57 publications

Postoperative delirium in geriatric patients with hip fractures

Postoperative delirium in geriatric patients with hip fractures

Comparison of logistic regression and machine learning methods for predicting postoperative delirium in elderly patients: A retrospective study

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

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