A randomized control trial comparing prophylactic dexmedetomidine versus clonidine on rates and duration of delirium in older adult patients undergoing coronary artery bypass grafting - 11/01/20
Abstract |
Study objective |
Postoperative delirium occurs in 20–50% of elderly patients undergoing cardiac surgery and increases morbidity and mortality. We investigated whether prophylactic dexmedetomidine could reduce delirium incidence in elderly patients after coronary artery bypass grafting (CABG), compared with clonidine.
Design |
Prospective observational trial.
Setting |
Academic university hospital.
Participants |
Patients (60–70 years old) who underwent CABG and received either dexmedetomidine or clonidine infusion postoperatively.
Interventions |
Patients were randomly allocated to dexmedetomidine or clonidine groups. In the dexmedetomidine group, patients received an initial infusion of 0.7–1.2 μg/kg/h; sedation and analgesia were evaluated after 45–60 min. If the Richmond assessment sedation score (RASS) increased from +1 to +4, the infusion rate was increased by 0.1–0.2 μg/kg/h every 30 min, up to 1–1.4 μg/kg body-weight/h. Dexmedetomidine infusion was not discontinued pre-extubation; thereafter, infusion was reduced by 0.1 μg/kg/h until 0.2 μg/kg/h. The maximum infusion duration was 72 h. In the clonidine group, patients received an initial infusion of 0.5 μg/kg, followed by 1–2 μg/kg/h, if the RASS changed from +1 to +4. This was continued throughout mechanical ventilation.
Measurements |
Patients were followed up to 5 days post-surgery. Delirium incidence, extubation time, lengths of intensive care unit (ICU) and hospital stay, need for inotropic support or vasopressors, mean arterial blood pressure and heart rate, hospital mortality rate, total postoperative morphine dose, number of patients receiving haloperidol, and adverse events were recorded.
Main results |
Two-hundred-and-eighty-six patients (dexmedetomidine, 144; clonidine, 142) were studied. Dexmedetomidine was associated with lower risk and duration of delirium, shorter mechanical ventilation duration and ICU stay, lower mortality rate, and lower morphine consumption than the clonidine group. Dexmedetomidine significantly decreased heart rates after ICU admission.
Conclusions |
Postoperative infusion of dexmedetomidine provides a feasible option for postoperative control of delirium after CABG in adult patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Dexmedetomidine sedation facilitates postoperative prevention and control of delirium. |
• | Dexmedetomidine reduces the length of hospital stay and extubation time. |
• | Dexmedetomidine reduces postoperative morphine consumption. |
• | Dexmedetomidine results in a lower incidence of complications than clonidine. |
Keywords : Clonidine, Coronary artery bypass grafting, Dexmedetomidine, Elderly patients, Haloperidol
Plan
Vol 61
Article 109622- mai 2020 Retour au numéro
Article précédent
- Anticholinergic burden of long-term medication is an independent risk factor for the development of postoperative delirium: A clinical trial
- Anika Mueller, Claudia D. Spies, Rahel Eckardt, Bjoern Weiss, Anne Pohrt, Klaus-Dieter Wernecke, Maren Schmidt, PERATECS-Group
- Comparison of clinical outcomes of acetaminophen IV vs PO in the peri-operative setting for laparoscopic inguinal hernia repair surgeries: A triple-blinded, randomized controlled trial
- Alopi Patel, Poonam Pai B.H., Dina Diskina, Brittany Reardon, Yan H. Lai
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?