- Design
- Secondary analysis of a randomised, double-blind, 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
- Effect
- 14.9% vs 34.7%; adjusted OR 0.31 (0.10-0.92)
This was a delirium-focused secondary analysis of a single-centre, double-blind, placebo-controlled trial. Adults having head and neck cancer surgery with free-flap reconstruction received dexmedetomidine 0.3 mcg/kg/h until an hour before the end of surgery, or saline. Delirium was screened daily for five days with CAM-ICU or 3D-CAM.
Delirium occurred in 7 of 47 patients (14.9%) given dexmedetomidine and 17 of 49 (34.7%) given placebo (adjusted OR 0.31, 95% CI 0.10 to 0.92). Pain and early sleep were better, and haemodynamic events and complications did not differ.
Delirium after major head and neck surgery delays mobilisation and flap monitoring and is distressing for families. The result is encouraging, but delirium was not the parent trial's primary outcome and the numbers are small. Dexmedetomidine is widely available in India; its use here is reasonable to discuss with the anaesthetic team, not yet a mandate.
- Screen for delirium daily after major head and neck surgery using a validated tool.
- Discuss intraoperative dexmedetomidine with the anaesthetist for older or cognitively vulnerable patients.
- Watch for bradycardia and hypotension when dexmedetomidine is used with free flaps.
- Keep non-drug measures in place: orientation, glasses and hearing aids, sleep and early mobilisation.
Why it matters
Delirium is a common, under-recognised complication after long head and neck operations.
Don't overread it
A secondary analysis of 96 patients from one centre; delirium was not the trial's primary outcome.
The statistics, in plain English
An adjusted odds ratio of 0.31 suggests a large reduction, but the interval runs from 0.10 to 0.92, so the true effect could be modest. Secondary analyses can find effects the original trial was not designed to test.
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