Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Lin Yi, He Bin, Chen Jian, Wang, Wang Zhi

Description

The aim of this study was to explore the use of dexmedetomidine as a safe and efficacious sedative agent in post-cardiac surgery patients. Methods A systematic literature search of MEDLINE, EMBASE, the Cochrane Library and Science Citation Index until January 2012 and review of studies was conducted. Eligible studies were of randomized controlled trials or cohort studies, comparing dexmedetomidine with a placebo or an alternative sedative agent in elective cardiac surgery, using dexmedetomidine for postoperative sedation and available in full text. Two reviewers independently performed study selection, quality assessment, and data extraction. Results The search identified 530 potentially relevant publications; 11 met selection criteria in this meta-analysis. Our results revealed that dexmedetomidine was associated with a shorter length of mechanical ventilation (mean difference -2.70 [-5.05, -0.35]), a lower risk of delirium (risk ratio 0.36 [0.21, 0.64]), ventricular tachycardia (risk ratio 0.27 [0.08, 0.97]) and hyperglycemia (risk ratio 0.78 [0.61, 0.99]), but may increase the risk of bradycardia (risk ratio 2.08 [1.16, 3.74]). But there was no significant difference in ICU stay, hospital stay, and morphine equivalents between the included studies. Dexmedetomidine may not increase the risk of hypotension, atrial fibrillation, postoperative nausea and vomiting, reintubation within 5 days, cardiovascular complications, postoperative infection or hospital mortality. Conclusions Dexmedetomidine was associated with shorter length of mechanical ventilation and lower risk of delirium following cardiac surgery. Although the risk of bradycardia was significantly higher compared with traditional sedatives, it may not increase length of hospital stay and hospital mortality. Moreover, dexmedetomidine may decrease the risk of ventricular tachycardia and hyperglycemia. Thus, dexmedetomidine could be a safe and efficacious sedative agent in cardiac surgical patients.

Sujets

• Bradycardia
• Hypotension
• Delírium
• Mechanical ventilation
• Intensive care unit
• Sédation

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 1 012
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Linet al.Critical Care2012,16:R169 http://ccforum.com/content/16/5/R169

R E S E A R C HOpen Access Can dexmedetomidine be a safe and efficacious sedative agent in postcardiac surgery patients? a metaanalysis 1†2†1 1* Yi Yun Lin, Bin He, Jian Chenand Zhi Nong Wang

Abstract Introduction:The aim of this study was to explore the use of dexmedetomidine as a safe and efficacious sedative agent in postcardiac surgery patients. Methods:A systematic literature search of MEDLINE, EMBASE, the Cochrane Library and Science Citation Index until January 2012 and review of studies was conducted. Eligible studies were of randomized controlled trials or cohort studies, comparing dexmedetomidine with a placebo or an alternative sedative agent in elective cardiac surgery, using dexmedetomidine for postoperative sedation and available in full text. Two reviewers independently performed study selection, quality assessment, and data extraction. Results:The search identified 530 potentially relevant publications; 11 met selection criteria in this metaanalysis. Our results revealed that dexmedetomidine was associated with a shorter length of mechanical ventilation (mean difference 2.70 [5.05, 0.35]), a lower risk of delirium (risk ratio 0.36 [0.21, 0.64]), ventricular tachycardia (risk ratio 0.27 [0.08, 0.97]) and hyperglycemia (risk ratio 0.78 [0.61, 0.99]), but may increase the risk of bradycardia (risk ratio 2.08 [1.16, 3.74]). But there was no significant difference in ICU stay, hospital stay, and morphine equivalents between the included studies. Dexmedetomidine may not increase the risk of hypotension, atrial fibrillation, postoperative nausea and vomiting, reintubation within 5 days, cardiovascular complications, postoperative infection or hospital mortality. Conclusions:Dexmedetomidine was associated with shorter length of mechanical ventilation and lower risk of delirium following cardiac surgery. Although the risk of bradycardia was significantly higher compared with traditional sedatives, it may not increase length of hospital stay and hospital mortality. Moreover, dexmedetomidine may decrease the risk of ventricular tachycardia and hyperglycemia. Thus, dexmedetomidine could be a safe and efficacious sedative agent in cardiac surgical patients. Keywords:Bradycardia, Hypotension, Delirium, Mechanical ventilation, Intensive care unit, Sedation

Introduction Sedation, used to reduce stress response and provide anxiolysis [1], is an important component of postoperative management following cardiac surgery. The ideal sedative for use after cardiac surgery would have an immediate onset of action, be effective at providing immediate resolu tion of the agitation and anxiety, allow rapid recovery after

* Correspondence: [e-mail] †Contributed equally 1 Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Fengyang road 415#, Shanghai, 200003, China Full list of author information is available at the end of the article

discontinuation, lack drug accumulation, have minimal adverse effects, and be costeffective [1,2]. However, no single agent or combination of agents has shown a clear superiority to meet these clinical standards [3]. Dexmedetomidine is a highly selective and potent cen trala 2 receptor agonist which binds to transmembrane G proteinbinding adrenoreceptors, and has no activity on thegaminobutyric acid (GABA) system [4]. By decreasing central nervous system sympathetic outflow, dexmedeto midine has analgesic effects known as opioidsparing [5]. This property is unique among sedatives used in the inten sive care unit (ICU) because it produces sedation and

© 2012 Lin et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.