The Influence Of Perioperative Dexmedetomidine On Patients Undergoing Cardiac Surgery:A Meta-analysis

ObjectiveWe conducted a meta-analysis comparing the postoperative complications in patients undergoing cardiac surgery with dexmedetomidine versus other perioperative medications to determine the influence of perioperative dexmedetomidine on cardiac surgery patients.MethodsThe following keywords were used to conduct a basic search: “heart surgery”,“cardiac surgery”,“heart valve”,“coronary artery bypass grafting”,“CABG”,“cardiopulmonary bypass”,“CPB”,and “dexmedetomidine”.Randomized or quasi-randomized controlled trials comparing outcomes in patients who underwent cardiac surgery with dexmedetomidine,another medication,or a placebo were retrieved systematically from EMBASE,PubMed,the Cochrane Library,and Science Citation Index.Several endpoints were chosen because of their importance in clinical practice and frequency of being reported.Selection of studies,quality assessment and data abstraction were conducted independently by two reviewers.Risk ratio(RR)were calculated for dichotomous outcomes while weighted mean difference(MD)were calculated for continuous outcomes.If heterogeneity is absent,either the fixed-effect model or a random-effect model to calculate pooled effects was chosen.ResultsA total of 1702 patients in 14 studies met the selection criteria among 1,535 studies that fit the research strategy.Compared to other medications,perioperative use of dexmedetomidine can reduce the risk of ventricular tachycardia(risk ratio [RR] 0.28,95% confidence interval [CI] 0.15,0.55,P = 0.0002)and postoperative delirium(RR 0.35,95% CI 0.20,0.62,P = 0.0004)but may increase the risk of bradycardia(RR 2.23,95% CI 1.36,3.67,P = 0.001).Our results also showed a trend toward a decrease in atrial fibrillation(RR 0.76,95% CI 0.55,1.06,P = 0.11)and an increase in hypotension(RR 1.08,95% CI 0.74,1.57,P = 0.69).In addition,dexmedetomidine may reduce the length of intensive care unit(ICU)and hospital stay.ConclusionsThis meta-analysis revealed that the perioperative use of dexmedetomidine in patients undergoing cardiac surgery can reduce the risk of postoperative ventricular tachycardia and delirium,but may increase the risk of bradycardia.The estimates showed a decreased risk of atrial fibrillation,shorter length of ICU stay and hospitalization,and increased risk of hypotension with dexmedetomidine.