Effectiveness and Safety of Dexmedetomidine for Postoperative Sedation in Cardiac Patients: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Limei , CHANG Xiaoli , REN Xuli ,  LV Huangwei

Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China;

Corresponding author：

LV Huangwei, Email: hwl1998@yahoo.com

Keywords：

Dexmedetomidine; Cardiac surgery; Postoperative sedation; Complication; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20130017

Video：

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Objective 　To evaluate the effectiveness and safety of dexmedetomidine for postoperative sedation in cardiac patients.
Methods 　Such databases as PubMed, EBSCO, Springer, Ovid, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched electronically from the date of their establishment to May 2012, and other relevant journals and references of the included literature were also searched manually. Two reviewers independently screened the studies in accordance with the inclusion and exclusion criteria, extracted data and assessed methodology quality. Then the meta-analysis was performed using RevMan 5.1software.
Results 　A total of 8 randomized controlled trials (RCTs) involving 1 157 patients were included. The Jadad scores of 7 RCTs were more than 3, and only 1 RCT scored 2. The results of meta-analysis showed that compared with the control group, dexmedetomidine significantly raised peripheral oxygen saturation (RR=0.90, 95%CI 0.31 to 0.49, P=0.003), decreased the incidence of average heart rate (RR=–5.86, 95%CI –7.31 to −4.40, P lt;0.000 01), ventricular tachycardia (RR=0.27, 95%CI 0.08 to 0.88, P=0.03), delirium (RR=0.28, 95%CI 0.16 to 0.48, P lt;0.000 01) and postoperative hyperglycemia (RR=0.57, 95%CI 0.38 to 0.85, P=0.006), and reduced the number of patients who needed vasoactive agents such as epinephrine (RR=0.53, 95%CI 0.29 to 0.96, P=0.04) and β-blocker (RR=0.60, 95%CI 0.38 to 0.94, P=0.03). However, it failed to shorten the time of both ICU stay (RR=−1.24, 95%CI −4.35 to 1.87, P=0.43) and mechanical ventilation (RR=−2.28, 95%CI −5.13 to 0.57, P=0.12), increase mean artery pressure (RR=−2.78, 95%CI −6.89 to 1.34, P=0.19), and well control postoperative nausea, vomiting and atrial-fibrillation. There were no significant differences between the two groups in myocardial infarction, acute cardiac failure, acute kidney failure, and mortality rate.
Conclusion 　For postoperative sedation in cardiac patients, dexmedetomidine can effectively stabilize hemodynamic indexes, and reduce tachycardia, delirium, postoperative hyperglycemia and vasoactive agents. However, it has no marked influence on the prognosis. For the quantity and quality limitation of included studies, this conclusion needs to be proved by performing more high quality and large sample RCTs.

Citation： WANG Limei,CHANG Xiaoli,REN Xuli,LV Huangwei. Effectiveness and Safety of Dexmedetomidine for Postoperative Sedation in Cardiac Patients: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(1): 93-99. doi: 10.7507/1672-2531.20130017 Copy

1.	Gregory B, Hammer MD, The role of alpha2 agonists in pediatric anesthesia. Canadian Journal of Anesthesia, 2005, 52(6): R1–R3.
2.	Virtanen R, Savola JM, Saano V, et al. Characterization of theselectivity, specificity and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol, 1988, 150(1-2): 9-14.
3.	Maze M, Scheinin M. Molecular pharmacology of a2-adrenergic receptors. Anaesth Pharmacol Rev, 1993, 1(4): 233-237.
4.	Shehabi Y, Ruettimann U, Adamson H, et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med, 2004, 30(12): 2188-2196.
5.	Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med, 2003, 29(2): 201-207.
6.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reportsof randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7.	Stephanie MC, Jill A, Christopher M, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
8.	Noorizan AA, Mui CC, Chow YY, et al. Efficacy and safety of dexmedetomidine versus morphinein post-operative cardiac surgery patients. Int J Clin Pharm, 2011, 33: 150-154.
9.	Daniel L, John SP, Michael E, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine based versus propofol-based sedation regimens. Journal of Cardiothoracic and Vascular Anesthesia, 2003, 17(50): 576-584.
10.	Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine domppared with morphine based therapy after cardiac surgery. Anesthesiology, 2009, 111(5): 1075–1084.
11.	胡雪莲, 贾明, 赵勇, 等. 右美托咪啶和咪达唑仑在心脏术后镇静作用的研究. 宁夏医学杂志, 2011, 33(10): 967-969.
12.	Jose R, Ashley W, Pieter JA, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
13.	Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of dexmedetomidine versus propofol-based sedation therapy in mechanically ventilated cardiac surgery patients at a tertiary academic medical center. Critical Pathways in Cardiology, 2010, 9(4): 222-226.
14.	Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. The Heart Surgery Forum, 2011, 14(2): E93-E98.
15.	孙捷豪, 韩宁, 吴秀英. 美托咪啶用于全身麻醉的随机对照试验的Meta分析. 中国循证医学杂志, 2008, 8(9): 773-778.
16.	Siobal MS, Kallet RH, Kivett VA, et al. Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir Care, 2006, 51(5): 492-496.
17.	MacLaren R, Forrest LK, Kiser TH. Adjunctive dexmedetomidine therapy in the intensive care unit: a retrospective assessment of impact on sedative and analgesic requirements, levels of sedation and analgesia, and ventilatory and hemodynamic parameters. Pharmacotherapy, 2007, 27(3): 351-359.
18.	Arpino PA, Kalafatas K, Thompson BT. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. J Clin Pharm Ther, 2008, 33(1): 25-30.

1. Gregory B, Hammer MD, The role of alpha2 agonists in pediatric anesthesia. Canadian Journal of Anesthesia, 2005, 52(6): R1–R3.
2. Virtanen R, Savola JM, Saano V, et al. Characterization of theselectivity, specificity and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol, 1988, 150(1-2): 9-14.
3. Maze M, Scheinin M. Molecular pharmacology of a2-adrenergic receptors. Anaesth Pharmacol Rev, 1993, 1(4): 233-237.
4. Shehabi Y, Ruettimann U, Adamson H, et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med, 2004, 30(12): 2188-2196.
5. Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med, 2003, 29(2): 201-207.
6. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reportsof randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7. Stephanie MC, Jill A, Christopher M, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
8. Noorizan AA, Mui CC, Chow YY, et al. Efficacy and safety of dexmedetomidine versus morphinein post-operative cardiac surgery patients. Int J Clin Pharm, 2011, 33: 150-154.
9. Daniel L, John SP, Michael E, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine based versus propofol-based sedation regimens. Journal of Cardiothoracic and Vascular Anesthesia, 2003, 17(50): 576-584.
10. Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine domppared with morphine based therapy after cardiac surgery. Anesthesiology, 2009, 111(5): 1075–1084.
11. 胡雪莲, 贾明, 赵勇, 等. 右美托咪啶和咪达唑仑在心脏术后镇静作用的研究. 宁夏医学杂志, 2011, 33(10): 967-969.
12. Jose R, Ashley W, Pieter JA, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
13. Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of dexmedetomidine versus propofol-based sedation therapy in mechanically ventilated cardiac surgery patients at a tertiary academic medical center. Critical Pathways in Cardiology, 2010, 9(4): 222-226.
14. Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. The Heart Surgery Forum, 2011, 14(2): E93-E98.
15. 孙捷豪, 韩宁, 吴秀英. 美托咪啶用于全身麻醉的随机对照试验的Meta分析. 中国循证医学杂志, 2008, 8(9): 773-778.
16. Siobal MS, Kallet RH, Kivett VA, et al. Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir Care, 2006, 51(5): 492-496.
17. MacLaren R, Forrest LK, Kiser TH. Adjunctive dexmedetomidine therapy in the intensive care unit: a retrospective assessment of impact on sedative and analgesic requirements, levels of sedation and analgesia, and ventilatory and hemodynamic parameters. Pharmacotherapy, 2007, 27(3): 351-359.
18. Arpino PA, Kalafatas K, Thompson BT. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. J Clin Pharm Ther, 2008, 33(1): 25-30.

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