Effect of dexmedetomidine on prognosis of patients after cardiac surgery with cardiopulmonary bypass: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 WANG Xiaowen ^1,2 , ZHANG Cheng ^1,2 , LI Linjun ^1,2 , ZHOU Ruiqin ^1,2 ,  HUANG Chun ¹ , JIANG Yingjiu ¹ , WU Qingchen ¹

1. Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R. China;
2. Department of Cardiothoracic Surgery ICU, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R. China;

Corresponding author：

HUANG Chun, Email: hcsurgery@163.com

Keywords：

Dexmedetomidine; cardiac surgery; meta-analysis; randomized controlled trial

DOI：

10.7507/1007-4848.201704027

Video：

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Objective To evaluate the clinical efficacy of dexmedetomidine in perioperative management of on-pump cardiac surgery. Methods Randomized controlled trials (RCTs) were identified through a systematic literature search of PubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database (up to December 2016). RevMan 5.3 software was used for meta-analysis. Results Sixteen studies with 1 432 patients were included. Dexmedetomidine significantly decreased the risk of postoperative delirium (RR=0.28, 95% CI 0.18 to 0.44, P<0.000 01) and postoperative atrial fibrillation (RR=0.65, 95% CI 0.44 to 0.98, P=0.04) compared with the controls. The duration of intubation (RR=–1.96, 95% CI –2.07 to –1.86, P<0.000 01), length of ICU stay (RR=–0.49, 95% CI –0.74, –0.24, P=0.000 1) and hospital stay (RR=–1.24, 95% CI –2.26 to –0.22, P=0.02) in the dexmedetomidine group were significantly shorter than those of the control group. In addition, dexmedetomidine was shown to improve the score of the the Montreal Cognitive Assessment (RR=0.88, 95% CI 0.42 to 1.35, P=0.000 2) compared to the control group. Conclusion Dexmedetomidine can reduce the complications after cardiac surgery, which is safe and effective. However, more studies with good methodologic quality and large samples are still needed to make further assessment.

Citation： WANG Xiaowen, ZHANG Cheng, LI Linjun, ZHOU Ruiqin, HUANG Chun, JIANG Yingjiu, WU Qingchen. Effect of dexmedetomidine on prognosis of patients after cardiac surgery with cardiopulmonary bypass: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(4): 325-332. doi: 10.7507/1007-4848.201704027 Copy

1.	Belleville JP, Ward DS, Bloor BC, et al. Effects of intravenous dexmedetomidine in humans. Ⅰ. Sedation, ventilation, and metabolic rate. Anesthesiology, 1992, 77(6): 1125-1133.
2.	Keating GM. Dexmedetomidine: A review of its use for sedation in the intensive care setting. Drugs, 2015, 75(10): 1119-1130.
3.	Jalonen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology, 1997, 86(2): 331-345.
4.	Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
5.	Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology, 2009, 111(5): 1075-1084.
6.	Abd Aziz N, Chue MC, Yong CY, et al. Efficacy and safety of dexmedetomidine versus morphine in post-operative cardiac surgery patients. Int J Clin Pharm, 2011, 33(2): 150-154.
7.	Tosun Z, Baktir M, Kahraman HC, et al. Does dexmedetomidine provide cardioprotection in coronary artery bypass grafting with cardiopulmonary bypass? A pilot study. J Cardiothorac Vasc Anesth, 2013, 27(4): 710-715.
8.	Kim HJ, Kim WH, Kim G, et al. A comparison among infusion of lidocaine and dexmedetomidine alone and in combination in subjects undergoing coronary artery bypass graft: a randomized trial. Contemp Clin Trials, 2014, 39(2): 303-309.
9.	Balkanay OO, Goksedef D, Omeroglu SN, et al. The dose-related effects of dexmedetomidine on renal functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting: a randomized, triple-blind, placebo-controlled study. Interact Cardiovasc Thorac Surg, 2015, 20(2): 209-214.
10.	黄坚. 右美托咪定对体外循环下瓣膜置换术患者炎症反应的影响. 南昌大学医学院, 2013. 1-27.
11.	丁付燕, 宋先荣, 程兆云. 右美托咪啶对冠状动脉旁路移植术后患者镇静效果的研究. 国际外科学杂志, 2014, 41(6): 401-404.
12.	张友华, 吕光宇, 张磊, 等. 右美托咪定与丙泊酚在心脏术后患者机械通气中应用的对比研究. 中国临床新医学, 2015, 8(5): 419-422.
13.	张玉辉, 高亚坤, 肖连波, 等. 右美托咪定在心脏瓣膜置换术围手术期中的应用研究. 现代中西医结合杂志, 2015, 24(35): 3962-3964.
14.	张玉辉, 高亚坤, 肖连波, 等. 右美托咪定用于心脏瓣膜置换手术后重症监护患者镇静效果观察. 实用药物与临床, 2015, 18(8): 923-925.
15.	梅玫, 顾尔伟, 符炜. 右美托咪定对心脏瓣膜置换术者认知功能影响. 安徽医科大学学报, 2016, 51(3): 426-431.
16.	吕慧敏, 张化, 李新峰, 等. 心脏手术中右美托咪定对患者心肌损伤标志物及术后认知功能的影响. 中华实验外科杂志, 2016, 33(6): 1664-1667.
17.	孙天宇, 李娜, 常家辉. 右美托咪定对心脏手术患者术后谵妄的影响. 临床医学研究与实践, 2016, 1(4): 13.
18.	宋先荣, 程兆云, 刘富荣, 等. 右美托咪定对冠状动脉旁路移植的心肌保护作用. 心血管外科杂志(电子版), 2015, 4(2): 76-80.
19.	Li A, Yuen VM, Goulay-Dufay S, et al. Pharmacokinetics and pharmacodynamics of dexmedetomidine. Drug Dev Ind Pharm, 2016, 42(12): 1917-1927.
20.	Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth, 2015, 115(2): 171-182.
21.	Wu HH, Wang HT, Jin JJ, et al. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. PLoS One, 2014, 9(3): e93114.
22.	Tong Y, Ren H, Ding X, et al. Analgesic effect and adverse events of dexmedetomidine as additive for pediatric caudal anesthesia: a meta-analysis. Paediatr Anaesth, 2014, 24(12): 1224-1230.
23.	Park SJ, Shin S, Kim SH, et al. Comparison of dexmedetomidine and fentanyl as an adjuvant to ropivacaine for postoperative epidural analgesia in pediatric orthopedic surgery. Yonsei Med J, 2017, 58(3): 650-657.
24.	Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol, 2008, 21(4): 457-461.
25.	Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology, 2000, 93(5): 1345-1349.
26.	Akpınar O, Nazıroğlu M, Akpınar H. Different doses of dexmedetomidine reduce plasma cytokine production, brain oxidative injury, PARP and caspase expression levels but increase liver oxidative toxicity in cerebral ischemia-induced rats. Brain Res Bull, 2017, 130: 1-9.
27.	Li Y, Liu S. The effect of dexmedetomidine on oxidative stress response following cerebral ischemia-reperfusion in rats and the expression of intracellular adhesion molecule-1(ICAM-1) and S100B. Med Sci Monit, 2017, 23: 867-873.
28.	Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol, 2008, 4(5): 619-627.
29.	Nie Y, Liu Y, Luo Q, et al. Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia: a randomised, placebo-controlled study. Eur J Anaesthesiol, 2014, 31(4): 197-203.
30.	Diao HX, Jiang S, Gao PY, et al. Comparison of the effects of propofol and emulsified isoflurane alone or combined with dexmedetomidine on induction of anesthesia in dogs. Vet Anaesth Analg, 2016, 43(2): 145-152.
31.	Kim KN, Lee HJ, Kim SY, et al. Combined use of dexmedetomidine and propofol in monitored anesthesia care: a randomized controlled study. BMC Anesthesiol, 2017, 17(1): 34.
32.	Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med, 2003, 114(9): 742-752.
33.	Leino K, Hynynen M, Jalonen J, et al. Renal effects of dexmedetomidine during coronary artery bypass surgery: a randomized placebo-controlled study. BMC Anesthesiol, 2011, 11: 9.
34.	Ji F, Li Z, Nguyen H, et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation, 2013, 127(15): 1576-1584.

1. Belleville JP, Ward DS, Bloor BC, et al. Effects of intravenous dexmedetomidine in humans. Ⅰ. Sedation, ventilation, and metabolic rate. Anesthesiology, 1992, 77(6): 1125-1133.
2. Keating GM. Dexmedetomidine: A review of its use for sedation in the intensive care setting. Drugs, 2015, 75(10): 1119-1130.
3. Jalonen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology, 1997, 86(2): 331-345.
4. Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
5. Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology, 2009, 111(5): 1075-1084.
6. Abd Aziz N, Chue MC, Yong CY, et al. Efficacy and safety of dexmedetomidine versus morphine in post-operative cardiac surgery patients. Int J Clin Pharm, 2011, 33(2): 150-154.
7. Tosun Z, Baktir M, Kahraman HC, et al. Does dexmedetomidine provide cardioprotection in coronary artery bypass grafting with cardiopulmonary bypass? A pilot study. J Cardiothorac Vasc Anesth, 2013, 27(4): 710-715.
8. Kim HJ, Kim WH, Kim G, et al. A comparison among infusion of lidocaine and dexmedetomidine alone and in combination in subjects undergoing coronary artery bypass graft: a randomized trial. Contemp Clin Trials, 2014, 39(2): 303-309.
9. Balkanay OO, Goksedef D, Omeroglu SN, et al. The dose-related effects of dexmedetomidine on renal functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting: a randomized, triple-blind, placebo-controlled study. Interact Cardiovasc Thorac Surg, 2015, 20(2): 209-214.
10. 黄坚. 右美托咪定对体外循环下瓣膜置换术患者炎症反应的影响. 南昌大学医学院, 2013. 1-27.
11. 丁付燕, 宋先荣, 程兆云. 右美托咪啶对冠状动脉旁路移植术后患者镇静效果的研究. 国际外科学杂志, 2014, 41(6): 401-404.
12. 张友华, 吕光宇, 张磊, 等. 右美托咪定与丙泊酚在心脏术后患者机械通气中应用的对比研究. 中国临床新医学, 2015, 8(5): 419-422.
13. 张玉辉, 高亚坤, 肖连波, 等. 右美托咪定在心脏瓣膜置换术围手术期中的应用研究. 现代中西医结合杂志, 2015, 24(35): 3962-3964.
14. 张玉辉, 高亚坤, 肖连波, 等. 右美托咪定用于心脏瓣膜置换手术后重症监护患者镇静效果观察. 实用药物与临床, 2015, 18(8): 923-925.
15. 梅玫, 顾尔伟, 符炜. 右美托咪定对心脏瓣膜置换术者认知功能影响. 安徽医科大学学报, 2016, 51(3): 426-431.
16. 吕慧敏, 张化, 李新峰, 等. 心脏手术中右美托咪定对患者心肌损伤标志物及术后认知功能的影响. 中华实验外科杂志, 2016, 33(6): 1664-1667.
17. 孙天宇, 李娜, 常家辉. 右美托咪定对心脏手术患者术后谵妄的影响. 临床医学研究与实践, 2016, 1(4): 13.
18. 宋先荣, 程兆云, 刘富荣, 等. 右美托咪定对冠状动脉旁路移植的心肌保护作用. 心血管外科杂志(电子版), 2015, 4(2): 76-80.
19. Li A, Yuen VM, Goulay-Dufay S, et al. Pharmacokinetics and pharmacodynamics of dexmedetomidine. Drug Dev Ind Pharm, 2016, 42(12): 1917-1927.
20. Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth, 2015, 115(2): 171-182.
21. Wu HH, Wang HT, Jin JJ, et al. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. PLoS One, 2014, 9(3): e93114.
22. Tong Y, Ren H, Ding X, et al. Analgesic effect and adverse events of dexmedetomidine as additive for pediatric caudal anesthesia: a meta-analysis. Paediatr Anaesth, 2014, 24(12): 1224-1230.
23. Park SJ, Shin S, Kim SH, et al. Comparison of dexmedetomidine and fentanyl as an adjuvant to ropivacaine for postoperative epidural analgesia in pediatric orthopedic surgery. Yonsei Med J, 2017, 58(3): 650-657.
24. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol, 2008, 21(4): 457-461.
25. Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology, 2000, 93(5): 1345-1349.
26. Akpınar O, Nazıroğlu M, Akpınar H. Different doses of dexmedetomidine reduce plasma cytokine production, brain oxidative injury, PARP and caspase expression levels but increase liver oxidative toxicity in cerebral ischemia-induced rats. Brain Res Bull, 2017, 130: 1-9.
27. Li Y, Liu S. The effect of dexmedetomidine on oxidative stress response following cerebral ischemia-reperfusion in rats and the expression of intracellular adhesion molecule-1(ICAM-1) and S100B. Med Sci Monit, 2017, 23: 867-873.
28. Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol, 2008, 4(5): 619-627.
29. Nie Y, Liu Y, Luo Q, et al. Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia: a randomised, placebo-controlled study. Eur J Anaesthesiol, 2014, 31(4): 197-203.
30. Diao HX, Jiang S, Gao PY, et al. Comparison of the effects of propofol and emulsified isoflurane alone or combined with dexmedetomidine on induction of anesthesia in dogs. Vet Anaesth Analg, 2016, 43(2): 145-152.
31. Kim KN, Lee HJ, Kim SY, et al. Combined use of dexmedetomidine and propofol in monitored anesthesia care: a randomized controlled study. BMC Anesthesiol, 2017, 17(1): 34.
32. Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med, 2003, 114(9): 742-752.
33. Leino K, Hynynen M, Jalonen J, et al. Renal effects of dexmedetomidine during coronary artery bypass surgery: a randomized placebo-controlled study. BMC Anesthesiol, 2011, 11: 9.
34. Ji F, Li Z, Nguyen H, et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation, 2013, 127(15): 1576-1584.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of dexmedetomidine on prognosis of patients after cardiac surgery with cardiopulmonary bypass: A systematic review and meta-analysis

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