Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 28, 2022; 10(1): 25-36
Published online Feb 28, 2022. doi: 10.13105/wjma.v10.i1.25
Effects of dexmedetomidine on cardioprotection and other postoperative complications in elderly patients after cardiac and non-cardiac surgerie
Yang-Liang Yang, Bao-Ji Hu, Jing Yi, Meng-Zhi Pan, Peng-Cheng Xie, Hong-Wei Duan
Yang-Liang Yang, Hong-Wei Duan, Department of Anesthesia, Pudong Hospital, Shanghai 201399, China
Bao-Ji Hu, Jing Yi, Meng-Zhi Pan, Peng-Cheng Xie, Department of Anesthesiology, Fudan University Pudong Medical Center, Fudan University, Shanghai 201399, China
Author contributions: Yang YL conceived and designed the study; Yi J, Hu BJ and Duan HW collected the data and performed the literature search; Yang YL was involved in the writing of the manuscript; Pan MZ and Xie PC contributed equally to this work; all authors have read and approved the final manuscript.
Supported by National Health and Family Planning Commission of the People's Republic of China, National Clinical Key Specialty Project Foundation, No. PWZzk2017-06.
Conflict-of-interest statement: The authors declare no competing interests.
PRISMA 2009 Checklist statement: We have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Wei Duan, Doctor, MHSc, Chief Physician, Professor, Department of Anesthesia, Pudong Hospital, No. 2800 Gongwei Road, Pudong New Area, Shanghai 201399, China. duanhongwei120@163.com
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: December 10, 2021
Revised: December 24, 2021
Accepted: February 12, 2022
Article in press: February 12, 2022
Published online: February 28, 2022
Processing time: 139 Days and 21.6 Hours
Abstract
BACKGROUND

After cardiac and non-cardiac surgeries, elderly patients have a high probability of developing cardiac complications and postoperative delirium. Although several clinical trials have investigated whether perioperative intravenous dexmedetomidine can protect the heart and reduce postoperative complications such as delirium in elderly patients, the obtained results have been inconsistent. We conducted a meta-analysis to investigate the effects of dexmedetomidine on cardioprotection and other postoperative complications in elderly patients undergoing cardiac or non-cardiac surgery.

AIM

To investigate the effects of dexmedetomidine on cardiac complications and delirium in elderly patients undergoing cardiac or non-cardiac surgery.

METHODS

The PubMed, Cochrane Library, web of science, and other sources were comprehensively searched for all randomized controlled trials published before May 2021 that investigated the efficacy of dexmedetomidine in the prevention of cardiac and postoperative delirium (POD).

RESULTS

In total, 18 studies involving 1025 patients were included in the meta-analysis. Intravenous dexmedetomidine significantly reduced cardiac troponin I (cTnI) and the inflammatory factor tumor necrosis factor-α (TNF-α) was comparable to the control group. Dexmedetomidine also reduced the POD and mortality rates. However, patients in the dexmedetomidine group were more likely to have a decreased heart rate (within the normal range) and hypotension during dexmedetomidine administration than those in the control group. There was no difference in the occurrence of myocardial infarction, bradycardia, or stroke between the two groups. Dexmedetomidine significantly shortened the time to extubate; however, it did not shorten the length of stay in the intensive care unit.

CONCLUSION

The administration of dexmedetomidine during cardiac and non-cardiac surgeries can provide myocardial protection by inhibiting inflammation and cTnI, which may be beneficial for the rapid recovery of patients. Meanwhile, the administration of dexmedetomidine reduced the incidence of POD and decreased mortality (in-hospital).

Keywords: Dexmedetomidine; Cardioprotection; Postoperative delirium; Complication; Meta-analysis

Core Tip: After cardiac and non-cardiac surgeries, elderly patients have a high probability of developing cardiac complications and postoperative delirium. Although several clinical trials have investigated whether perioperative intravenous dexmedetomidine can protect the heart and reduce postoperative complications such as delirium in elderly patients, the obtained results have been inconsistent. We conducted a meta-analysis to investigate the effects of dexmedetomidine on cardioprotection and other postoperative complications in elderly patients undergoing cardiac or non-cardiac surgery.