Anestéziológia a intenzívna medicína 1/2015

Dexmedetomidine in the prevention of postoperative delirium in cardiac surgery patients

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. This paper represents a prospective clinical observational study. It is single center study realized in a tertiary level of care facility from October 2013 to February 2014. Two consecutive groups of 250 consecutive patients took part in the study. The first was the control group and the second was the dexmedetomidine group. In second group, the patients received perioperative dexmedetomidine sedation. Main outcome 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. The incidence of the delirium was 5.2 % in the dexmedetomidine group versus 20.8 % in control group (p = 0.001). Predictors of delirium in dexmedetomidine group were age (p = 0.001), higher EuroSCORE II value (p = 0.035), longer CPB time (p = 0.018), sufentanil dose > 0.15 mg (p = 0.014) and valve combined operations (p = 0.036). In multivariate analysis only age (p = 0.001) was predictor. Comparing the groups together predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), CPB time (p = 0.001), ACC time (p = 0.004), sufentanil dose (p = 0.010), CABG (p = 0.015). Perioperative sedation with dexmedetomidine significantly decreases the incidence of postoperative delirium after cardiac surgery. Perioperative sedation with dexmedetomidine should be considered in every patient scheduled for cardiac surgery.

Keywords: dexmedetomidine, prevention, delirium, cardiac surgery.