Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery

作者：Stacie Deiner, Xiaodong Luo, Hung‐Mo Lin, Daniel I. Sessler, Leif Saager, Frederick E. Sieber, Hochang B. Lee, Mary Sano, and the Dexlirium Writing Group, Christopher J. Jankowski, Sergio D. Bergese, Keith Candiotti, Joseph H. Flaherty, Harendra Arora, Aryeh Shander, Peter Rock · 发表于：JAMA Surgery · 年份：2017 · DOI：10.1001/jamasurg.2017.1505 · 被引用次数：345 · 研究领域：Intensive Care Unit Cognitive Disorders、Anesthesia and Sedative Agents、Enhanced Recovery After Surgery

IMPORTANCE: Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. OBJECTIVE: To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium. DESIGN, SETTING, AND PARTICIPANTS: This study was a multicenter, double-blind, randomized, placebo-controlled trial that randomly assigned patients to dexmedetomidine or saline placebo infused during surgery and for 2 hours in the recovery room. Patients were assessed daily for postoperative delirium (primary outcome) and secondarily for postoperative cognitive decline. Participants were elderly (>68 years) patients undergoing major elective noncardiac surgery. The study dates were February 2008 to May 2014. INTERVENTIONS: Dexmedetomidine infusion (0.5 µg/kg/h) during surgery and up to 2 hours in the recovery room. MAIN OUTCOMES AND MEASURES: The primary hypothesis tested was that intraoperative dexmedetomidine administration would reduce postoperative delirium. Secondarily, the study examined the correlation between dexmedetomidine use and postoperative cognitive change. RESULTS: In total, 404 patients were randomized; 390 completed in-hospital deliriu...