Intraoperative dexamethasone and delirium after cardiac surgery: a randomized clinical trial

Sauër, AC; Slooter, AJ; Veldhuijzen, Dieuwke S.; Eijk, MM Van; Dijk, Diederik van

doi:10.1186/cc12334

Cited by 18 publications

(52 citation statements)

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“…Table 1 shows the characteristics of the included studies. Four of the included studies involved cardiac surgery [22][23][24][25], while the remaining one involved microvascular decompression surgery [26].…”

Section: Study Selectionmentioning

confidence: 99%

“…Four studies used a two-arm design in comparing dexamethasone to placebo except 1, which used a three-arm design [26]. Three studies assessed the effects of dexamethasone on POCD [22,24,26], while two studies investigated the effects of dexamethasone on POD [23,25].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two studies reported the incidence of POD, in which the data was reported as the number of participants [23,25]. Mardani et al reported the incidence of POD at the preoperative day, followed by the first, second, and third postoperative days, in order to avoid double counting and given that POD typically occurs 2 to 3 days after surgery, we only selected the results reported on the third postoperative day [23].…”

Section: Incidence Of Podmentioning

confidence: 99%

“…Mardani et al reported the incidence of POD at the preoperative day, followed by the first, second, and third postoperative days, in order to avoid double counting and given that POD typically occurs 2 to 3 days after surgery, we only selected the results reported on the third postoperative day [23]. Sauer et al reported the incidence of the first 4 postoperative days [25].…”

Section: Incidence Of Podmentioning

confidence: 99%

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Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Fang

et al. 2019

Preprint

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Background Several studies have investigated the effects of dexamethasone on postoperative cognitive dysfunction (POCD) or postoperative delirium (POD); however, their conclusions have not been consistent. So we conducted a meta-analysis to determine the effects of dexamethasone on POCD/POD in adults following general anesthesia. Methods Cochrane Central Register of Controlled Trials (CENTRAL, 2018, Issue 11 of 12) in the Cochrane Library (searched November 17, 2018); MEDLINE OvidSP (1946 to November 16, 2018); and Embase OvidSP (1974 to November 16, 2018) were searched for randomized controlled trials that evaluated the incidence of POCD/POD following dexamethasone administration, in adults (age ≥18 years) under general anesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess the quality of evidence. Results Five studies were included (three studies/855 participants in dexamethasone group and 538 participants in placebo group for the incidence of POCD, and two studies/410 participants in dexamethasone group and 420 participants in placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD in 30 days after surgery (RR 1.00; 95% CI [0.51, 1.96], P = 1.00, I2 = 77%) or in the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I2 = 0%). However, both analyses had some limitations since evidence remains limited and clinical heterogeneity, and we considered the quality of the evidence for the postoperative incidence of POCD and POD to be very low. Conclusions This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative prevent strategies for POCD/POD, and a better understanding of the pathophysiology of those complex syndrome, are still needed to make progress of this field. Trial registration number: This study is registered with PROSPERO, 23 October 2018, number CRD42018114552.

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Incidence Of Podmentioning

confidence: 99%

Section: Incidence Of Podmentioning

confidence: 99%

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Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Fang

et al. 2019

Preprint

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“…88 Na verdade, a prática da utilização de antipsicóticos para a profilaxia do delirium deve ser individualizada, devido aos eventos adversos, como risco de morte e de outras complicações em pacientes idosos causadas por essas drogas. 89 A administração profilática de dexametasona na indução anestésica 90 , para reduzir a subsequente cascata inflamatória sistêmica e neurológica na cirurgia, não reduziu a incidência ou a duração do delirium quando comparado com o placebo, em estudo com pacientes submetidos à cirurgia cardíaca com circulação extracorpórea.…”

Section: (Figura 3)unclassified

Postoperative delirium in the elderly: Where are we?

Bisinotto¹,

Silveira²,

Silva³

et al. 2017

Revista Médica De Minas Gerais

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RESUMO Complicações neurológicas no período pós-operatório podem ser devastadoras para os pacientes e seus familiares. E, apesar da importância do sistema nervoso central, os anestesiologistas têm praticamente ignorado a sua função no período pré-operatório, já que todos os recursos são quase totalmente desviados para outros sistemas, principalmente o cardiovascular. Essa assertiva pretende realçar o fato de não existir um monitor padrão para o cérebro ou outras estruturas neurais durante a cirurgia e a anestesia, enquanto que monitores para os sistemas cardiovascular e respiratório têm sido utilizados rotineiramente por décadas. Em vista do aumento da longevidade da população, há maior número de pacientes idosos que estão sendo submetidos a procedimentos cirúrgicos, e eles representam o grupo de alto risco para o comprometimento cognitivo pós-operatório, em vista da existência aumentada de comorbidades. O impacto da anestesia nesses pacientes é pouco compreendido, mas o aparecimento do delirium pós-operatório é um problema sério, pois pode evoluir para deficiência cognitiva permanente e aumento da mortalidade. O objetivo desta revisão é familiarizar os anestesiologistas com a incidência, fatores de risco, diagnóstico, prevenção e tratamento do delirium pós-operatório, com a finalidade de chamar a atenção para a sua existência e englobar os mesmos em todas as áreas de cuidados, juntamente com psiquiatras, enfermagem e gestores hospitalares.

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Use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults: a nested case–control study

Cole

McCusker

Wilchesky

et al. 2016

Int J Geriat Psychiatry

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Intraoperative dexamethasone and delirium after cardiac surgery: a randomized clinical trial

Cited by 18 publications

References 1 publication

Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Postoperative delirium in the elderly: Where are we?

Use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults: a nested case–control study

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