The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Cardiac Surgery

医学 围手术期 右美托咪定 安慰剂 荟萃分析 随机对照试验 谵妄 心脏外科 入射(几何) 麻醉 镇静 科克伦图书馆 神经认知 术后认知功能障碍 认知 内科学 心脏病学 重症监护医学 精神科 病理 替代医学 物理 光学
作者
Amara Singh,Connor T. A. Brenna,J Broad,Lilia Kaustov,Stephen Choi
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:275 (5): 864-871 被引量:10
标识
DOI:10.1097/sla.0000000000005196
摘要

Objective: The purpose of this systematic review and meta-analysis is to examine the effect of DEX on delayed dNCR (cognitive dysfunction ≥ 1 week postoperative) after cardiac surgery. Background: DEX has salutary effects on cognitive outcomes following cardiac surgery, however, studies are limited by inconsistent assessment tools, timing, and definitions of dysfunction. It is imperative to identify accurate point estimates of effect of DEX on clinically relevant changes in cognitive function. Methods: Randomized trials of adults undergoing cardiac surgery comparing perioperative DEX to placebo or alternate sedation and assessing cognitive function ≥ 1 week postoperative were included. Data was abstracted by three reviewers independently and in parallel according to PRISMA guidelines. The primary outcome is dNCR. To classify as dNCR, cognitive function must decrease by at least the minimal clinically important difference or accepted alternate measure (eg, Reliable Change Index ≥1.96). Bias was assessed with the Cochrane Collaboration tool. Data was pooled using a random effects model. Results: Nine trials (942 participants) were included in qualitative analysis, of which seven were included in the meta-analysis of dNCR. DEX reduced the incidence of dNCR (OR 0.39, 95% CI 0.25–0.61, P < 0.0001) compared to placebo/no DEX. There was no difference in the incidence of delirium (OR 0.69, 95% CI 0.35–1.34, P = 0.27) or incidence of hemodynamic instability (OR 1.14, 95% CI 0.59–2.18, P = 0.70) associated with perioperative DEX. Conclusions: DEX reduced the incidence of dNCR 1 week after cardiac surgery. Although this meta-analysis demonstrates short term cognitive outcomes are improved after cardiac surgery with perioperative DEX, future trials examining long term cognitive outcomes, using robust cognitive assessments, and new perioperative neurocognitive disorders nomenclature with objective diagnostic criteria are necessary.
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