June 21, 2021

Dexmedetomidine and delirium

The sedative dexmedetomidine, when administered during or after heart surgery, is associated with postoperative delirium and adverse outcomes.

by Paul Govern

Dexmedetomidine was approved in 1999 and today is used mainly in the intensive care setting for light to moderate sedation. Post-market studies of the drug have produced inconsistent safety results.  

In new findings that are exclusively with regard to cardiac surgery patients, intraoperative dexmedetomidine — that is, the drug as administered during heart surgery — is associated with 85% greater risk of postoperative delirium and 29% greater risk of postoperative intubation and reintubation.  

Meanwhile, dexmedetomidine administered to cardiac surgery patients postoperatively in the ICU is associated with 25% greater risk of 30-day mortality. 

These findings, reported in The Annals of Thoracic Surgery by Miklos Kertai, MD, PhD, and colleagues, are based on records of 54,682 cardiac surgery patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The patients underwent cardiac surgery between July 2014 and December 2018. 

Dexmedetomidine was also associated with minor, somewhat inconsistent differences in pain scores (at postop day three and hospital discharge).

On the study also from Vanderbilt University Medical Center were Ashish Shah, MD, Xiaoke Feng, MS, and Matthew Shotwell, PhD. They were joined by researchers from Virginia Commonwealth University, Johns Hopkins School of Medicine, the Cleveland Clinic Foundation and Missoula Anesthesiology.