Perioperative Medicine  |   February 2016
Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial
Author Notes
  • From the Department of Anesthesia and Pain Management (G.D., N.S., L.F., J.C., R.K.), Department of Psychiatry (R.S.), and Division of Cardiovascular Surgery (V.R.), Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • The abstract has been presented at the 37th Society of Cardiovascular Anesthesiologists Annual Meeting, April 11–15, 2015, Washington, D.C.
    The abstract has been presented at the 37th Society of Cardiovascular Anesthesiologists Annual Meeting, April 11–15, 2015, Washington, D.C.×
  • Submitted for publication June 3, 2015. Accepted for publication October 7, 2015.
    Submitted for publication June 3, 2015. Accepted for publication October 7, 2015.×
  • Address correspondence to Dr. Djaiani: Department of Anesthesia and Pain Management, EN3-410, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. george.djaiani@uhn.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Pharmacology
Perioperative Medicine   |   February 2016
Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial
Anesthesiology 2 2016, Vol.124, 362-368. doi:10.1097/ALN.0000000000000951
Anesthesiology 2 2016, Vol.124, 362-368. doi:10.1097/ALN.0000000000000951
Abstract

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−1 h−1 infusion) or propofol (25 to 50 μg kg−1 min−1 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.

Abstract

When compared with propofol, dexmedetomidine sedation reduced incidence, delayed onset, and shortened duration of postoperative delirium in elderly patients after cardiac surgery.