Cardiology Letters 2015, 24(6):435-434

The role of dexmedetomidine in the prevention of postoperative delirium in cardiac surgery patients

Bily B, Artemiou P, Sabol F, Bilecova-Rabajdova M, Kolarcik P, Torok P

¹ University of P.J. Safarik in Kosice, Medical Faculty, Dept. of Cardiovascular Surgery, Eastern Slovak Institute for Cardiovascular Diseases, Kosice

² University of P.J. Safarik in Kosice, Medical Faculty, Dept. of Clinical Biochemistry

³ University of P.J. Safarik in Kosice, Medical Faculty, Dept. of Public Health

⁴ University of P.J. Safarik in Kosice, Medical Faculty, Dept. of Cardiac Anesthesia, Eastern Slovak Institute for Cardiovascular Diseases, Kosice, Slovak Republic

Objective: Post cardiac surgery delirium is a severe complication. Dexmedetomidine is a highly selective shorter-acting intravenous alpha-2-agonist and has a protective effect on specific organs including the heart, brain, kidney and lungs. It was hypothesized that perioperative administration of dexmedetomidine would decrease the incidence of the postoperative delirium in cardiac surgery patients.

Methods: This paper represents a prospective non-randomized clinical observational study. It is a single center study realized in a tertiary level of care facility from April 2013 to February 2014. Two consecutive groups of 250 consecutive patients took part in the study. Group A was the control group and group B was the dexmedetomidine group. In group B, the patients received perioperative dexmedetomidine sedation. The main aim of the measures was to observe the incidence of delirium and to identify any predictors of delirium and to compare the two groups based on the delirium incidence.

Results: The incidence of the delirium was 5.2% in the dexmedetomidine group vs. 20.8% in control group (p=0.001). Predictors of delirium in the dexmedetomidine group were age (p=0.001, 95% CI 1.068-1.271), higher EuroSCORE II value (p=0.035, 95% CI 1.007-1.198), longer CPB time (p=0.018, 95% CI 1.271-13.443), sufentanil dose > 0.15mg (p=0.014, 95% CI 5.394-3.403) and valve combined operations (p=0.036, 95% CI 4.420-1.099). In multivariate analysis only age (p=0.001, 95% CI 1.067-1.303) was a predictor. Comparing the groups together predictors of delirium were age (p=0.001, 95% CI 1.062-1.137), EuroSCORE II value (p=0.001, 95% CI 1.076-1.246), CPB time (p=0.001, 95% CI 1.004-1.015), ACC time (p=0.004, 95% CI 1.003-1.016), sufentanil dose (p=0.010, 95% CI 16.649-61.867), CABG (p=0.015, 95% CI 1.157-3.791).

Conclusion: Perioperative sedation with dexmedetomidine significantly decreases the incidence of postoper­ ative delirium after cardiac surgery and perioperative strategies should continue be developed, in order to further decrease the incidence of the postoperative delirium. Perioperative sedation with dexmedetomidine should be considered in every patient scheduled for cardiac surgery.

Keywords: dexmedetomidine; prevention; delirium; cardiac surgery

Published: June 1, 2015  Show citation