Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial
| Autor: | Frederick E. Sieber, Leif Saager, Keith A. Candiotti, Harendra Arora, Daniel I. Sessler, Christopher J. Jankowski, Aryeh Shander, Stacie Deiner, Mary Sano, Hochang B. Lee, Xiaodong Luo, Hung-Mo Lin, Sergio D. Bergese, Joseph H. Flaherty, Peter Rock |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Sedation Placebo law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications Randomized controlled trial Double-Blind Method 030202 anesthesiology law Interquartile range mental disorders medicine Adrenergic alpha-2 Receptor Agonists Humans Cognitive Dysfunction Treatment Failure Cognitive decline Dexmedetomidine Infusions Intravenous Aged Intraoperative Care business.industry Delirium Intensive care unit Surgery Elective Surgical Procedures Anesthesia Female medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | JAMA surgery. 152(8) |
| ISSN: | 2168-6262 |
| Popis: | Importance Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. Objective To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium. Design, Setting, and Participants This study was a multicenter, double-blind, randomized, placebo-controlled trial that randomly assigned patients to dexmedetomidine or saline placebo infused during surgery and for 2 hours in the recovery room. Patients were assessed daily for postoperative delirium (primary outcome) and secondarily for postoperative cognitive decline. Participants were elderly (>68 years) patients undergoing major elective noncardiac surgery. The study dates were February 2008 to May 2014. Interventions Dexmedetomidine infusion (0.5 µg/kg/h) during surgery and up to 2 hours in the recovery room. Main Outcomes and Measures The primary hypothesis tested was that intraoperative dexmedetomidine administration would reduce postoperative delirium. Secondarily, the study examined the correlation between dexmedetomidine use and postoperative cognitive change. Results In total, 404 patients were randomized; 390 completed in-hospital delirium assessments (median [interquartile range] age, 74.0 [71.0-78.0] years; 51.3% [200 of 390] female). There was no difference in postoperative delirium between the dexmedetomidine and placebo groups (12.2% [23 of 189] vs 11.4% [23 of 201],P = .94). After adjustment for age and educational level, there was no difference in the postoperative cognitive performance between treatment groups at 3 months and 6 months. Adverse events were comparably distributed in the treatment groups. Conclusions and Relevance Intraoperative dexmedetomidine does not prevent postoperative delirium. The reduction in delirium previously demonstrated in numerous surgical intensive care unit studies was not observed, which underscores the importance of timing when administering the drug to prevent delirium. Trial Registration clinicaltrials.gov IdentifierNCT00561678 |
| Databáze: | OpenAIRE |
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