Intraoperative dexmedetomidine was linked to less delirium after head and neck free-flap surgery

Design

Delirium-focused secondary analysis of a single-centre randomised, double-blind, placebo-controlled trial

Population

96 adults having head and neck cancer surgery with free-flap reconstruction (47 dexmedetomidine, 49 placebo)

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)

This is a delirium-focused secondary analysis of a single-centre, double-blind, placebo-controlled randomised trial in adults having elective head and neck cancer surgery with free-flap reconstruction. Patients received dexmedetomidine 0.3 micrograms per kg per hour until an hour before the end of surgery, or saline. Delirium was assessed daily for five days with CAM-ICU or 3D-CAM.

Delirium occurred in 14.9% (7 of 47) with dexmedetomidine and 34.7% (17 of 49) with placebo. After adjustment for age, baseline Mini-Mental State Examination score and operative time, the 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 adverse events and postoperative complications did not differ significantly.

With 96 patients, one centre and a secondary analysis, the estimate is imprecise, and the interval nearly reaches 1. It supports a larger confirmatory trial and a discussion with anaesthetic colleagues for older or cognitively vulnerable patients, not a change in practice.

• Delirium within 5 days was 14.9% with dexmedetomidine and 34.7% with placebo.
• Adjusted OR was 0.31 (95% CI 0.10 to 0.92).
• Haemodynamic adverse events did not differ significantly.
• Only 96 patients from one centre.
• Discuss the option with the anaesthetic team for patients at higher delirium risk.

Why it matters

Delirium after long reconstructive operations extends stay and is distressing, and few preventive options exist.

Don't overread it

A secondary analysis of a small single-centre trial cannot establish that dexmedetomidine prevents delirium.

The statistics, in plain English

An adjusted odds ratio of 0.31 with an interval of 0.10 to 0.92 suggests roughly two-thirds lower odds of delirium, but the range runs from a very large effect to almost none. A secondary analysis was not the trial's original primary question, so it is hypothesis-generating.

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