Perioperative dexmedetomidine reduces delirium in elderly patients after non-cardiac surgery: a systematic review and meta-analysis of randomized-controlled trials

Pan, Hao; Liu, Chengxiao; Ma, Xiaochun; Xu, Yanyan; Zhang, Mengyuan; Wang, Yan

doi:10.1007/s12630-019-01440-6

Cited by 49 publications

(35 citation statements)

References 28 publications

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“…Additionally, we conducted a subgroup analysis for noncardiac surgery and cardiac surgery. The subgroup analysis confirmed the results of recent meta-analyses, 19,20 which demonstrated a reduced delirium incidence after dexmedetomidine administration in elderly patients for noncardiac surgery with sufficient evidence from TSA and moderate quality rated by GRADE. Additionally, 5 cardiac surgical studies in this analysis demonstrated that dexmedetomidine did not prevent delirium incidence in elderly patients, with moderate heterogeneity ( I 2 = 67%).…”

Section: Discussionsupporting

confidence: 81%

“…These meta-analyses revealed that dexmedetomidine reduced delirium occurrence, mechanical ventilation, and the duration of hospital stay. 18-20 Furthermore, most randomized controlled trials (RCTs) have found similar results on the efficacy of dexmedetomidine in treatment of delirium for geriatric patients undergoing cardiac surgery. 21-25 However, Deiner et al 26 compared dexmedetomidine with placebo and published inconsistent findings after noncardiac surgery.…”

Section: Introductionmentioning

confidence: 94%

“…Many meta-analyses have demonstrated a decrease in delirium occurrence after noncardiac surgery among geriatric surgical patients. [18][19][20]48 There are several advantages in our analysis. First, studies with elderly patients undergoing cardiac surgery were not included in these analyses.…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

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Effect of Dexmedetomidine on Delirium in Elderly Surgical Patients: A Meta-analysis of Randomized Controlled Trials

Lin

Jie

et al. 2020

Ann Pharmacother

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Objective: The purpose of this meta-analysis is to assess the effect of dexmedetomidine on delirium in elderly surgical patients. Data Sources: The Cochrane Library, Web of Science, PubMed, EMBASE, and Google Scholar were searched (January 1, 2000, to February 4, 2020) for randomized controlled trials (RCTs). Study Selection and Data Extraction: RCTs without language restrictions were included if delirium incidence was assessed in elderly surgical patients receiving dexmedetomidine. Intervention and basic information were extracted. Data Synthesis: 21 studies were included. Dexmedetomidine reduced delirium occurrence (risk ratio [RR] = 0.55; 95% CI = 0.45 to 0.67) in elderly surgical patients with sufficient evidence from trial sequential analysis. Dexmedetomidine did not prevent delirium incidence for cardiac surgery (RR = 0.71; 95% CI = 0.44 to 1.15) with insufficient evidence. Dexmedetomidine decreased mortality incidence (RR = 0.47; 95% CI = 0.25 to 0.89), shortened the length of intensive care unit (ICU; standard mean difference [SMD] = −0.46) and hospital stays (SMD = −0.41), and increased bradycardia incidence (RR = 1.60). Relevance to Patient Care and Clinical Practice: This review revealed that dexmedetomidine could reduce delirium incidence for elderly noncardiac surgical patients, and the effect of dexmedetomidine on delirium for elderly cardiac surgical patients needs further studies to guide clinicians. Conclusion: Dexmedetomidine reduced delirium incidence in elderly surgical patients. The efficacy of dexmedetomidine on delirium for elderly cardiac surgical patients warrants further studies. Furthermore, dexmedetomidine was associated with an increased bradycardia incidence, shorter length of ICU/hospital stays, and a lower incidence of mortality.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 94%

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Effect of Dexmedetomidine on Delirium in Elderly Surgical Patients: A Meta-analysis of Randomized Controlled Trials

Lin

Jie

et al. 2020

Ann Pharmacother

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“…Two systematic 2019 meta-analyses of RCTs showed that in elderly patients undergoing noncardiac surgery, perioperative administration of dexmedetomidine, compared with placebo, reduced the incidence of POD [145,146]. In contrast, a 2019 double-blinded, multi-center, randomized study that included 164 elderly patients undergoing cardiac surgery reported that dexmedetomidine-based GA resulted in reduced extubation time and postoperative morphine requirements when compared with propofol-based GA, but no significant difference was observed in POD incidence [147].…”

Section: Postoperative Deliriummentioning

confidence: 99%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

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“…A VÝSKYT DELIRIA U GERIATRICKÝCH PACIENTŮ [10] Delirium je častou komplikací v pooperačním období. Je spojeno se zvýšenou morbiditou a mortalitou.…”

Section: Perioperačně Podávaný Dexmedetomidinunclassified