Key result
Prophylactic use of dexmedetomidine significantly reduced the incidence of postoperative delirium (RR 0.61) compared to placebo in elderly patients undergoing noncardiac surgery.
Why the study?
Postoperative delirium among elderly patients undergoing noncardiac surgery is linked to adverse outcomes, motivating an evaluation of the effectiveness and safety of prophylactic dexmedetomidine.
Does prophylactic dexmedetomidine reduce the incidence of postoperative delirium in elderly patients undergoing noncardiac surgery?
Meta-Analysis (n=2,102)
Does prophylactic dexmedetomidine reduce the incidence of postoperative delirium in elderly patients undergoing noncardiac surgery?
Relative Risk: 0.61 (95% CI 0.34–0.76)
Absolute Event Rate: 10.2% vs 20.2%
p-value: p=0.001
Prophylactic dexmedetomidine reduces the incidence of postoperative delirium in elderly patients undergoing noncardiac surgery, though it increases the risk of bradycardia.
Supports prophylaxis consideration in elderly noncardiac surgery; confirms delirium reduction in meta-analysis with bradycardia monitoring needed.
BACKGROUND: Postoperative delirium (POD) among the elderly population that undergoes noncardiac surgery is significantly associated with adverse clinical outcomes. We conducted this meta-analysis to evaluate the effectiveness and safety of dexmedetomidine for the prophylaxis of POD among the elderly population after noncardiac surgery. METHODS: We searched Embase, PubMed, and the Cochrane Library from inception date to March 2019 for randomized controlled trials (RCTs) that compared dexmedetomidine and placebo for the prevention of POD and evaluated the major cardiovascular outcomes among elderly people after noncardiac surgery. Two authors independently screened the studies and extracted data from the published articles. The main outcome was the incidence of POD. The secondary outcomes included the occurrence of bradycardia, hypotension, hypertension, tachycardia, myocardial infarction, stroke, hypoxaemia, and all-cause mortality. RESULTS: A total of 6 RCTs with 2102 participants were included. Compared with placebo, dexmedetomidine significantly reduced the prevalence of POD (RR = 0.61, 95% CI 0.34-0.76, P = 0.001, I2 = 66%), and the risk of tachycardia (RR = 0.48, 95% CI 0.30-0.76, P = 0.002, I2 = 0%), hypertension (RR = 0.59, 95% CI 0.44-0.79, P < 0.001, I2 = 20%), stroke (RR = 0.22, 95% CI 0.06-0.76, P = 0.02, I2 = 0%), and hypoxaemia (RR = 0.50, 95% CI 0.32-0.78, P = 0.002, I2 = 0%) in elderly patients who underwent noncardiac surgery. However, dexmedetomidine accelerated the occurrence of bradycardia (RR = 1.36, 95% CI 1.11-1.67, P = 0.003, I2 = 0%). Furthermore, no significant differences were observed in the incidence of hypotension, myocardial infarction, and all-cause mortality between the dexmedetomidine and placebo groups. CONCLUSIONS: Among elderly patients after noncardiac surgery, the prophylactic use of dexmedetomidine, compared with the use of placebo, was related to a decline in the incidence of POD.
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Zeng et al. (2019) conducted a meta-analysis in Postoperative delirium (n=2,102). Dexmedetomidine vs. Placebo was evaluated on Incidence of postoperative delirium (POD) (RR 0.61, 95% CI 0.34-0.76, p=0.001). Prophylactic use of dexmedetomidine significantly reduced the incidence of postoperative delirium (RR 0.61) compared to placebo in elderly patients undergoing noncardiac surgery.
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