Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery.
BACKGROUND
Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances.


OBJECTIVE
The authors investigated the effects of postoperative sedation on the development of delirium in patients undergoing cardiac-valve procedures.


METHODS
Patients underwent elective cardiac surgery with a standardized intraoperative anesthesia protocol, followed by random assignment to one of three postoperative sedation protocols: dexmedetomidine, propofol, or midazolam.


RESULTS
The incidence of delirium for patients receiving dexmedetomidine was 3%, for those receiving propofol was 50%, and for patients receiving midazolam, 50%. Patients who developed postoperative delirium experienced significantly longer intensive-care stays and longer total hospitalization.


CONCLUSIONS
The findings of this open-label, randomized clinical investigation suggest that postoperative sedation with dexmedetomidine was associated with significantly lower rates of postoperative delirium and lower care costs.
Maldonado
José R
JR
Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Suite 2317, Stanford, CA 94305-5546, USA. jrm@stanford.edu
Wysong
Ashley
A
van der Starre
Pieter J A
PJ
Block
Thaddeus
T
Miller
Craig
C
Reitz
Bruce A
BA
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D003693:Delirium / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy*; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam; D015742:Propofol