Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial
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 &mgr;g/kg bolus followed by 0.2 to 0.7 &mgr;g kg 1 h 1 infusion) or propofol (25 to 50 &mgr;g 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.
Anesthesiology