Perioperative Dexmedetomidine Supplement Decreases Delirium Incidence After Adult Cardiac Surgery: A Randomized, Double-Blind, Controlled Study

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 35; no. 2; pp. 449 - 457
• Main Authors: Likhvantsev, Valery V., Landoni, Giovanni, Grebenchikov, Oleg A., Ovezov, Alexey M., Skripkin, Yuri V., Lembo, Rosalba, Gaevskiy, Dmitry I., Tereshina, Anna A., Yavorovskiy, Andrey G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2021
• Subjects: Adult; anesthesia; cardiac surgery; Cardiac Surgical Procedures - adverse effects; cardiopulmonary bypass; Delirium - epidemiology; Delirium - prevention & control; Dexmedetomidine; Double-Blind Method; Humans; Hypnotics and Sedatives - adverse effects; Incidence; outcomes; postoperative delirium; cardiopulmonary bypass; cardiac surgery; dexmedetomidine; postoperative delirium; outcomes; anesthesia
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2020.02.035

Conflicting data exist on the effect of dexmedetomidine on delirium. For the present study, a randomized trial was performed to investigate the effect of perioperative dexmedetomidine on the rate of postoperative delirium after cardiac surgery. A randomized controlled trial. University hospital. Patients (n = 169) undergoing elective cardiac surgery (coronary artery bypass graft surgery, valve surgery, or combined surgery) with cardiopulmonary bypass. Patients received a sevoflurane-based general anesthesia and were randomly assigned 1:1 to receive a dexmedetomidine infusion that started in the operating room (0.7 μg/kg/h) and continued into the intensive care unit (0.4 μg/kg/h) or an equivolume infusion of placebo. A decrease in the rate of delirium in the dexmedetomidine group compared with the placebo group was demonstrated (6 of 84 [7.1%] v 16 of 85 [18.8%]; p = 0.02; odds ratio [OR] 0.33 [95% confidence interval {CI} 0.12-0.90]). Reduced intensive care unit and hospital lengths of stay also were observed (18 [18-22] hours v 22 [18-39] hours; p = 0.002 and 17 [7-20] days v 19 [8-21] days; p = 0.04, respectively). Mortality at 30 days was 2 (2.4%) in both groups. On multivariate analysis, only dexmedetomidine administration (OR 0.24 [95% CI 0.08-0.74]) and cardiopulmonary bypass time (OR 1.02 [95% CI 1.01-1.03] for increases of 1 min) were independent predictors of delirium development. Dexmedetomidine administered during and after general anesthesia for cardiac surgery with cardiopulmonary bypass decreased the rate of postoperative delirium and intensive care unit and hospital lengths of stay.