title: Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial.
abstract: BACKGROUND
  Postoperative delirium (POD) is a serious complication after cardiac surgery. Use of dexmedetomidine to prevent delirium is controversial. The authors hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD.
  
  
  METHODS
  After institutional ethics review board approval, and informed consent, a single-blinded, prospective, randomized controlled trial was conducted in patients 60 yr or older undergoing cardiac surgery. Patients with a history of serious mental illness, delirium, and severe dementia were excluded. Upon admission to intensive care unit (ICU), patients received either dexmedetomidine (0.4 μg/kg bolus followed by 0.2 to 0.7 μg kg h infusion) or propofol (25 to 50 μg kg min infusion) according to a computer-generated randomization code in blocks of four. Assessment of delirium was performed with confusion assessment method for ICU or confusion assessment method after discharge from ICU at 12-h intervals during the 5 postoperative days. Primary outcome was the incidence of POD.
  
  
  RESULTS
  POD was present in 16 of 91 (17.5%) and 29 of 92 (31.5%) patients in dexmedetomidine and propofol groups, respectively (odds ratio, 0.46; 95% CI, 0.23 to 0.92; P = 0.028). Median onset of POD was on postoperative day 2 (1 to 4 days) versus 1 (1 to 4 days), P = 0.027, and duration of POD 2 days (1 to 4 days) versus 3 days (1 to 5 days), P = 0.04, in dexmedetomidine and propofol groups, respectively.
  
  
  CONCLUSIONS
  When compared with propofol, dexmedetomidine sedation reduced incidence, delayed onset, and shortened duration of POD in elderly patients after cardiac surgery. The absolute risk reduction for POD was 14%, with a number needed to treat of 7.1.
authors.affiliation: From the Department of Anesthesia and Pain Management (G.D., N.S., L.F., J.C., R.K.), Department of Psychiatry (R.S.), and Division of Cardiovascular Surgery (V.R.), Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Djaiani
authors.forename: Natalie
authors.initials: N
authors.lastname: Silverton
authors.forename: Ludwik
authors.initials: L
authors.lastname: Fedorko
authors.forename: Jo
authors.initials: J
authors.lastname: Carroll
authors.forename: Rima
authors.initials: R
authors.lastname: Styra
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Rita
authors.initials: R
authors.lastname: Katznelson
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003693:Delirium / Q000517:prevention & control*; D020927:Dexmedetomidine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol