Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial

Reviewed as evidence on: Surgery / general anesthesia and postoperative delirium and cognitive decline 2 studies (what the news said). Being listed means the study bears on the question, not that it agrees with the news.

Topic: Risk, prevention and care in population studies

Background Postoperative delirium (POD) is a serious complication after cardiac surgery. Use of dexmedetomidine to prevent delirium is controversial. The authors hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD. Methods After institutional ethics review board approval, and informed consent, a single-blinded, prospective, randomized controlled trial was conducted in patients 60 yr or older undergoing cardiac surgery. Patients with a history of serious mental illness, delirium, and severe dementia were excluded. Upon admission to intensive care unit (ICU), patients received either dexmedetomidine (0.4 μg/kg bolus followed by 0.2 to 0.7 μg kg h infusion) or propofol (25 to 50 μg kg min infusion) according to a computer-generated randomization code in blocks of four. Assessment of delirium was performed with confusion assessment method for ICU or confusion assessment method after discharge from ICU at 12-h intervals during the 5 postoperative days. Primary outcome was the incidence of POD. Results POD was present in 16 of 91 (17.5%) and 29 of 92 (31.5%) patients in dexmedetomidine and propofol groups, respectively (odds ratio, 0.46; 95% CI, 0.23 to 0.92; P = 0.028). Median onset of POD was on postoperative day 2 (1 to 4 days) versus 1 (1 to 4 days), P = 0.027, and duration of POD 2 days (1 to 4 days) versus 3 days (1 to 5 days), P = 0.04, in dexmedetomidine and propofol groups, respectively. Conclusions When compared with propofol, dexmedetomidine sedation reduced incidence, delayed onset, and shortened duration of POD in elderly patients after cardiac surgery. The absolute risk reduction for POD was 14%, with a number needed to treat of 7.1.

@article{djaiani2016-26575144,
  author  = {Djaiani, G. and Silverton, N. and Fedorko, L. and Carroll, J. and Styra, R. and Rao, V. and Katznelson, R.},
  title   = {{Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial}},
  journal = {Anesthesiology},
  year    = {2016},
  doi     = {10.1097/aln.0000000000000951},
  pmid    = {26575144},
  url     = {https://doi.org/10.1097/aln.0000000000000951}
}

Key findings

• Results POD was present in 16 of 91 (17.5%) and 29 of 92 (31.5%) patients in dexmedetomidine and propofol groups, respectively (odds ratio, 0.46; 95% CI, 0.23 to 0.92; P = 0.028).
• Median onset of POD was on postoperative day 2 (1 to 4 days) versus 1 (1 to 4 days), P = 0.027, and duration of POD 2 days (1 to 4 days) versus 3 days (1 to 5 days), P = 0.04, in dexmedetomidine and propofol groups, respectively.
• Conclusions When compared with propofol, dexmedetomidine sedation reduced incidence, delayed onset, and shortened duration of POD in elderly patients after cardiac surgery.

Why it matters

In this randomized controlled trial of patients aged 60 and older undergoing cardiac surgery, postoperative delirium occurred in 17.5% of the dexmedetomidine group versus 31.5% of the propofol group. Dexmedetomidine sedation reduced the incidence, delayed the onset, and shortened the duration of postoperative delirium compared with propofol.

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Study details

• Study designrandomized controlled trial
• Effect size17.5%; 31.5%
• Evidence strengthHigh

Read the original

• DOI: 10.1097/aln.0000000000000951
• PubMed: 26575144
• Original source →

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Studies this one cites

Referenced by this study and also in the alzhub library, so you can read them here.

• Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit JAMA · 2004-04-01 · usefulness score 74/100 · How common it is
• Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU) JAMA · 2001-12-01 · usefulness score 72/100 · Getting a diagnosis

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Also tagged “anesthesia-surgery-and-cognition”

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• Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults JAMA surgery · 2015-12-01 · usefulness score 68/100 · How common it is

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