title: The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients.
abstract: OBJECTIVE
  The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery.
  
  
  METHODS
  Retrospective investigation.
  
  
  METHODS
  Patients from a single tertiary medical center.
  
  
  METHODS
  A total of 505 patients (≥65 years old) who underwent coronary artery bypass graft (CABG) or valve surgery. CABG and/or valve surgery plus other procedures were divided into 2 groups: 283 received intravenous Dex infusion (Dex group) and 222 did not (Non-Dex group).
  
  
  METHODS
  Perioperative Dex intravenous infusion (0.24 to 0.6 μg/kg/h) initiated after cardiopulmonary bypass and continued for<24 hours postoperatively in the ICU.
  
  
  RESULTS
  Data were risk adjusted, propensity score weighted, and multivariate logistic regression was used. The primary outcome was mortality. Secondary outcomes included postoperative stroke, coma, myocardial infarction, heart block, cardiac arrest, delirium, renal failure, and sepsis. Perioperative Dex infusion significantly decreased in-hospital mortality (0.90% v 2.83%; adjusted odds ratio (OR), 0.099; 95% confidence interval (CI), 0.030-0.324; p = 0.004) and operative mortality (1.35% v 3.18%; adjusted OR, 0.251; 95% CI, 0.077-0.813; p = 0.021). Perioperative Dex treatment also reduced the risk of stroke (0.90% v 1.77%; adjusted OR, 0.15; 95% CI, 0.038-0.590; p = 0.007), and delirium (7.21% v 10.95%; adjusted OR, 0.35; 95% CI, 0.212-0.578; p < 0.0001).
  
  
  CONCLUSIONS
  Results from this study (ClinicalTrials.gov identifier: NCT01683448) suggested perioperative use of dexmedetomidine was associated with decreases in in-hospital and operative mortality in elderly patients following cardiac surgery. It also reduced incidences of postoperative stroke and delirium in elderly patients.
authors.affiliation: Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, CA. Electronic address: hualiu@ucdavis.edu.
authors.forename: Hao
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Internal Medicine, University of California Davis Health System, Sacramento, CA.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Li
authors.affiliation: Surgery, University of California Davis Health System, Sacramento, CA.
authors.forename: Nilas
authors.initials: N
authors.lastname: Young
authors.affiliation: Surgery, University of California Davis Health System, Sacramento, CA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Boyd
authors.affiliation: Surgery, University of California Davis Health System, Sacramento, CA.
authors.forename: Zane
authors.initials: Z
authors.lastname: Atkins
authors.affiliation: Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Fuhai
authors.initials: F
authors.lastname: Ji
authors.affiliation: Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, CA.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003693:Delirium / Q000209:etiology / Q000517:prevention & control; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D020927:Dexmedetomidine
keywords: dexmedetomidine; elderly cardiac surgery; hospital mortality; outcome operative mortality