Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: A randomized controlled trial

Xue Li,Jing Yang,Xiao-Lu Nie,Dong-Xin Wang,Li-Huan Li,Daqing Ma,Yan Zhang,Xue-Ying Li,Felipe Dal Pizzol

doi:10.1371/journal.pone.0170757

Abstract

BackgroundDelirium is a frequent complication after cardiac surgery and its occurrence is associated with poor outcomes. The purpose of this study was to investigate the impact of perioperative dexmedetomidine administration on the incidence of delirium in elderly patients after cardiac surgery.MethodsThis randomized, double-blinded, and placebo-controlled trial was conducted in two tertiary hospitals in Beijing between December 1, 2014 and July 19, 2015. Eligible patients were randomized into two groups. Dexmedetomidine (DEX) was administered during anesthesia and early postoperative period for patients in the DEX group, whereas normal saline was administered in the same rate for the same duration for patients in the control (CTRL) group. The primary endpoint was the incidence of delirium during the first five days after surgery. Secondary endpoints included the cognitive function assessed on postoperative days 6 and 30, the overall incidence of non-delirium complications within 30 days after surgery, and the all-cause 30-day mortality.ResultsTwo hundred eighty-five patients were enrolled and randomized. Dexmedetomidine did not decrease the incidence of delirium (4.9% [7/142] in the DEX group vs 7.7% [11/143] in the CTRL group; OR 0.62, 95% CI 0.23 to 1.65, p = 0.341). Secondary endpoints were similar between the two groups; however, the incidence of pulmonary complications was slightly decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the percentage of early extubation was significantly increased (OR 3.32, 95% CI 1.36 to 8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased the required treatment for intraoperative tachycardia (21.1% [30/142] in the DEX group vs 33.6% [48/143] in the CTRL group, p = 0.019), but increased the required treatment for postoperative hypotension (84.5% [120/142] in the DEX group vs 69.9% [100/143] in the CTRL group, p = 0.003).ConclusionsDexmedetomidine administered during anesthesia and early postoperative period did not decrease the incidence of postoperative delirium in elderly patients undergoing elective cardiac surgery. However, considering the low delirium incidence, the trial might have been underpowered.Trial RegistrationClinicalTrials.gov NCT02267538

Highlights

Delirium is a common complication after cardiac surgery, with reported incidences varied from 3% to 47% [1]
Dexmedetomidine did not decrease the incidence of delirium (4.9% [7/142] in the DEX group vs 7.7% [11/143] in the CTRL group; odds ratio (OR) 0.62, 95% CI 0.23 to 1.65, p = 0.341)
Dexmedetomidine administered during anesthesia and early postoperative period did not decrease the incidence of postoperative delirium in elderly patients undergoing elective cardiac surgery

Summary

Introduction

Delirium is a common complication after cardiac surgery, with reported incidences varied from 3% to 47% [1]. For patients undergoing cardiac surgery, use of dexmedetomidine during general anesthesia decreased the consumption of opioid and other anesthetic drugs [10,11], and use of dexmedetomidine for sedation after surgery shortened the duration of mechanical ventilation and decreased the incidence of delirium [12,13]. We hypothesized that use of dexmedetomidine as an anesthetic adjuvant during cardiac surgery decreased the incidence of delirium, possibly by sparing the consumption of general anesthetics. Evidence in this aspect was still lacking. The purpose of this study was to investigate the impact of perioperative dexmedetomidine administration on the incidence of delirium in elderly patients after cardiac surgery

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Conclusion