Abstract
This study aimed to evaluate the efficacy and safety of dexmedetomidine versus any other treatment without dexmedetomidine in patients who have undergone cardiac surgery. Electronic databases including PubMed, Embase, and Cochrane Library were systematically searched without limitations of language and publication time. Randomized controlled trials (RCTs) aiming to evaluate the efficacy and safety of dexmedetomidine versus any other treatment without dexmedetomidine in patients that have undergone cardiac surgery were selected. Endpoints such as hemodynamic indexes and adverse events in eligible studies were extracted by two researchers, independently. The data was analyzed using RevMan 5.3 and Stata 11.0 software. A total of 18 RCTs met the inclusion criteria, involving 1730 patients. Compared to control (any treatment without dexmedetomidine), dexmedetomidine showed a pooled mean difference (MD) of -14.46 [95% confidence interval(CI): -24.69, -4.23; p<0.01] for systolic arterial pressure, a standardized mean difference (SMD) of -1.74 for mean arterial blood pressure (95% CI: -2.80, -0.68; P < 0.01), -2.12 (95%CI: -3.23, -1.00; p<0.01) for heart rate, and combined odds ratio (OR) of 0.22 (95%CI: 0.11, 0.44; p<0.01) for tachycardia, 3.44 (95%CI: 1.95, 5.96; p<0.01) for bradycardia, 0.74 (95%CI: 0.49, 1.12; p>0.05) for atrial fibrillation, and 0.99 (95%CI: 0.51, 1.90; p>0.05) for hypotension. In addition, dexmedetomidine could reduce time of surgery and stay in intensive care units, improve delirium with good safety. Our study shows clinical application of dexmedetomidine in cardiac surgery patients can reduce risks of abnormal hemodynamics with good safety.
Highlights
More than 2 million cardiac surgeries are performed in the world annually [1]
A total of 753 literatures were retrieved, and the literatures were screened strictly according to the inclusion and exclusion criteria by two reviewers, independently. 595 of these references were discarded after the first screen process
The results showed that significant difference in incidence of bradycardia was found between the dexmedetomidine group and the control group (OR = 3.44, 95% confidence interval (CI): 1.99, 5.96; P
Summary
More than 2 million cardiac surgeries are performed in the world annually [1]. While cardiac surgery is often used to treat complications of ischemic heart disease, correct congenital heart disease, or treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis, these procedures have several disadvantages [2,3,4]. Cardiac surgery is suggested to be associated with high risks of cardiovascular complications and other adverse events when performing operations, which are often resulted in increased hospital stay. Great improvements in equipment, techniques and medical care have been achieved, and decreased the incidences of major complication rates and mortality [11,12,13,14,15,16], effective and safe perioperative medication is required to further reduce these negative events [8,11,17,18]. Several studies suggested that dexmedetomidine may be useful for the treatment of the negative cardiovascular effects of cardiac surgery [21,22,23,24,25,26]. The utilization of this medication was limited in clinical practice as its common side effects such as hypotension and bradycardia, and higher economic costs [11,27]
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