Impact of postoperative dexmedetomidine infusion on incidence of delirium in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial

Nov 8, 2019Drug design, development and therapy

Dexmedetomidine infusion after surgery and its effect on delirium in older adults having major non-heart surgery

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Abstract

The incidence of postoperative was 11.7% in the group and 13.8% in the placebo group.

Postoperative continuous infusion of dexmedetomidine did not significantly reduce the incidence of delirium compared to placebo.
The study involved 557 patients aged 65 years or older undergoing major elective noncardiac surgery.
Patients receiving dexmedetomidine reported significantly lower pain scores at multiple time points after surgery.
Significant improvements in sleep quality were observed in the dexmedetomidine group during the first 3 postoperative days.
Adverse events related to dexmedetomidine were similar to those in the placebo group.

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PURPOSE: Postoperative is a serious and common complication, it occurs in 13-50% of elderly patients after major surgery, and presages adverse outcomes. Emerging literature suggests that sedation in critical care units (intensive care unit) is associated with reduced incidence of delirium. However, few studies have investigated whether postoperative continuous infusion of dexmedetomidine could safely decrease the incidence of delirium in elderly patients admitted to general surgical wards after noncardiac surgery.

PATIENTS AND METHODS: This double-blind, randomized, placebo-controlled trial was conducted in patients aged 65 years or older undergoing major elective noncardiac surgery without a planned ICU stay. Eligible patients were randomly assigned to receive either dexmedetomidine (0.1 μg/kg/h) or placebo (0.9% normal saline) immediately after surgery though patient-controlled intravenous analgesia device. The primary outcome was the incidence of delirium during the first 5 postoperative days. Secondary outcomes included postoperative subjective pain scores and subjective sleep quality. The study dates were from January 2018 to January 2019.

RESULTS: A total of 557 patients were randomly assigned to receive either dexmedetomidine (n=281) or placebo (n=276). The incidence of postoperative delirium had no difference between the dexmedetomidine and placebo groups (11.7% [33 of 281] vs 13.8% [38 of 276],=0.47). Compared with placebo group, patients in dexmedetomidine group reported significant lower numerical rating score pain scores at 3, 12, 24, and 48 hrs after surgery (all<0.05) and significant improved Richards Campbell Sleep Questionnaire results during the first 3 postoperative days (all<0.0001). Dexmedetomidine-related adverse events were similar between the two groups. P P P

CONCLUSION: Postoperative continuous infusion of dexmedetomidine did not decrease the incidence of postoperative delirium in elderly patients admitted to general surgical wards after elective noncardiac surgery.

Key numbers

11.7%

Incidence of

occurred in 33 of 281 patients in the group.

23.5% of 281 patients

Pain Rescue Requirement

Compared to 33.7% of 276 patients in the placebo group.

RCSQ scores significantly higher

Sleep Quality Improvement

Measured on the first three postoperative mornings.

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Impact of postoperative dexmedetomidine infusion on incidence of delirium in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial

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