Dexmedetomidine during surgery: less delirium in a small randomised analysis

Design

Secondary analysis of a single-centre randomised placebo-controlled trial

Population

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

Primary outcome

Delirium in the first 5 postoperative days (CAM-ICU or 3D-CAM)

Effect

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

This was a delirium-focused secondary analysis of a single-centre, double-blind, placebo-controlled trial in adults having elective head and neck cancer surgery with free-flap reconstruction. Intraoperative dexmedetomidine 0.3 µg/kg/h was stopped an hour before the end of surgery, and the control group received saline.

Delirium in the first five postoperative days, screened daily with the CAM-ICU or 3D-CAM, occurred in 14.9% (7 of 47) given dexmedetomidine and 34.7% (17 of 49) given placebo. The adjusted odds ratio was 0.31 (95% CI 0.10 to 0.92; p=0.036). Pain and early sleep outcomes were better with dexmedetomidine, and haemodynamic events and complications did not differ significantly.

A secondary analysis of 96 patients in one centre gives a wide interval, and the population is head and neck surgery rather than general older medical or orthopaedic patients. It is a signal for larger trials, not a basis for routine use in older adults.

• Delirium was 14.9% with dexmedetomidine against 34.7% with placebo over five days.
• The interval for the adjusted odds ratio was wide (0.10 to 0.92).
• Check for bradycardia and hypotension; adverse event rates were not significantly different here.
• Keep non-drug delirium prevention in place regardless: orientation, sleep, hydration, hearing and vision aids.

Why it matters

It adds a drug-based option to delirium prevention in surgical patients, a field where few drugs have worked.

Don't overread it

A secondary analysis of one small single-centre trial; it does not change delirium prevention guidance.

The statistics, in plain English

An odds ratio of 0.31 with an interval from 0.10 to 0.92 is compatible with a large benefit or a modest one, with a lower bound just under 1. In a 96-patient secondary analysis, a single extra event could shift the result.

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