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.	黃堅. 右美托咪定對體外循環下瓣膜置換術患者炎癥反應的影響. 南昌大學醫學院, 2013. 1-27.
11.	丁付燕, 宋先榮, 程兆云. 右美托咪啶對冠狀動脈旁路移植術后患者鎮靜效果的研究. 國際外科學雜志, 2014, 41(6): 401-404.
12.	張友華, 呂光宇, 張磊, 等. 右美托咪定與丙泊酚在心臟術后患者機械通氣中應用的對比研究. 中國臨床新醫學, 2015, 8(5): 419-422.
13.	張玉輝, 高亞坤, 肖連波, 等. 右美托咪定在心臟瓣膜置換術圍手術期中的應用研究. 現代中西醫結合雜志, 2015, 24(35): 3962-3964.
14.	張玉輝, 高亞坤, 肖連波, 等. 右美托咪定用于心臟瓣膜置換手術后重癥監護患者鎮靜效果觀察. 實用藥物與臨床, 2015, 18(8): 923-925.
15.	梅玫, 顧爾偉, 符煒. 右美托咪定對心臟瓣膜置換術者認知功能影響. 安徽醫科大學學報, 2016, 51(3): 426-431.
16.	呂慧敏, 張化, 李新峰, 等. 心臟手術中右美托咪定對患者心肌損傷標志物及術后認知功能的影響. 中華實驗外科雜志, 2016, 33(6): 1664-1667.
17.	孫天宇, 李娜, 常家輝. 右美托咪定對心臟手術患者術后譫妄的影響. 臨床醫學研究與實踐, 2016, 1(4): 13.
18.	宋先榮, 程兆云, 劉富榮, 等. 右美托咪定對冠狀動脈旁路移植的心肌保護作用. 心血管外科雜志(電子版), 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.	Akp?nar O, Naz?ro?lu M, Akp?nar 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. 黃堅. 右美托咪定對體外循環下瓣膜置換術患者炎癥反應的影響. 南昌大學醫學院, 2013. 1-27.
11. 丁付燕, 宋先榮, 程兆云. 右美托咪啶對冠狀動脈旁路移植術后患者鎮靜效果的研究. 國際外科學雜志, 2014, 41(6): 401-404.
12. 張友華, 呂光宇, 張磊, 等. 右美托咪定與丙泊酚在心臟術后患者機械通氣中應用的對比研究. 中國臨床新醫學, 2015, 8(5): 419-422.
13. 張玉輝, 高亞坤, 肖連波, 等. 右美托咪定在心臟瓣膜置換術圍手術期中的應用研究. 現代中西醫結合雜志, 2015, 24(35): 3962-3964.
14. 張玉輝, 高亞坤, 肖連波, 等. 右美托咪定用于心臟瓣膜置換手術后重癥監護患者鎮靜效果觀察. 實用藥物與臨床, 2015, 18(8): 923-925.
15. 梅玫, 顧爾偉, 符煒. 右美托咪定對心臟瓣膜置換術者認知功能影響. 安徽醫科大學學報, 2016, 51(3): 426-431.
16. 呂慧敏, 張化, 李新峰, 等. 心臟手術中右美托咪定對患者心肌損傷標志物及術后認知功能的影響. 中華實驗外科雜志, 2016, 33(6): 1664-1667.
17. 孫天宇, 李娜, 常家輝. 右美托咪定對心臟手術患者術后譫妄的影響. 臨床醫學研究與實踐, 2016, 1(4): 13.
18. 宋先榮, 程兆云, 劉富榮, 等. 右美托咪定對冠狀動脈旁路移植的心肌保護作用. 心血管外科雜志(電子版), 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. Akp?nar O, Naz?ro?lu M, Akp?nar 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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