Intraoperative dexmedetomidine linked to less delirium after free-flap surgery

Design

Secondary analysis of a single-centre double-blind randomised trial

Population

96 adults having head and neck cancer surgery with free-flap reconstruction

Primary outcome

Delirium in the first 5 postoperative days

Effect

14.9% vs 34.7%; adjusted OR 0.31 (95% CI 0.10 to 0.92)

A secondary analysis of a single-centre, double-blind randomised trial (Drug Design, Development and Therapy, 2 October) looked at 96 adults having head and neck cancer surgery with free-flap reconstruction. Patients received dexmedetomidine 0.3 micrograms per kg per hour or saline until an hour before the end of surgery, and were screened daily for delirium for five days.

Delirium occurred in 14.9% (7 of 47) with dexmedetomidine and 34.7% (17 of 49) with placebo; adjusted OR 0.31 (95% CI 0.10 to 0.92). Pain and early sleep were also better, and haemodynamic adverse events and complications did not differ.

These patients are at high delirium risk from long operations and airway changes, and a low-dose infusion is simple to give. But this was a secondary analysis of a small trial, and larger trials of perioperative dexmedetomidine have been mixed. It is reasonable to consider in high-risk patients, not a reason to make it routine.

• Consider a low-dose intraoperative dexmedetomidine infusion in patients at high risk of delirium after long head and neck surgery.
• Screen for delirium daily after major head and neck surgery with a validated tool such as CAM-ICU or 3D-CAM.
• Watch for bradycardia and hypotension during dexmedetomidine infusion, especially in older patients.
• Combine pharmacological measures with non-drug delirium prevention, including sleep, orientation and early mobilisation.

Why it matters

It adds to the case for dexmedetomidine in a group where delirium is common and disrupts flap care.

Don't overread it

This was a secondary analysis of a 96-patient single-centre trial; delirium was not the original primary outcome.

The statistics, in plain English

An adjusted odds ratio of 0.31 suggests substantially lower odds of delirium, but the interval (0.10 to 0.92) is wide and its upper end close to 1, so the true effect could be much smaller.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.