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Neurocognitive dysfunction risk alleviation with the use of dexmedetomidine in perioperative conditions or as ICU sedation: a meta-analysis.

Li B, Wang H, Wu H, Gao C - Medicine (Baltimore) (2015)

Bottom Line: Many studies have reported the beneficial effects of dexmedetomidine on postoperative neurocognitive function but overall evidence is not as clear.Dexmedetomidine use in the perioperative conditions or as ICU sedation is associated with lower risk of neurocognitive dysfunction.There can be some impact of neurocognitive assessment method, drug interactions, and clinical heterogeneity on the overall outcomes of this meta-analysis.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Anesthesiology (BL, HW, CG), Jinan General Hospital, PLA Jinan Military Area Command, Jinan; and Department of Anesthesiology (HW), The People's Hospital of Zhangqiu, Zhangqiu, Shandong, China.

ABSTRACT
Many studies have reported the beneficial effects of dexmedetomidine on postoperative neurocognitive function but overall evidence is not as clear. We examined this conundrum by meta-analyzing studies that used dexmedetomidine in perioperative conditions or as intensive care unit (ICU) sedation and utilized reliable neurocognitive assessment tests. The literature search was undertaken across several electronic databases including EBSCO, Embase, Google Scholar, Ovid SP, PubMed, Scopus, and Web of Science. Literature search was carried out across several electronic databases and relevant studies were selected after following précised inclusion criteria. Meta-analysis of risk differences (RDs) was carried out and subgroup analyses were performed. Twenty studies were selected from which data of 2612 individuals were used. Initial dexmedetomidine dose was 0.68 ± 0.27 and maintenance dose was 0.54 ± 0.32 in the trials. Dexmedetomidine treatment was associated with significantly lower risk of postoperative/postanesthesia neurocognitive dysfunction both in comparison with saline-treated controls (RD [95% confidence interval, CI]: -0.17 (-0.30, -0.04); P = 0.008) and comparators (-0.16 [-0.28, -0.04]; P = 0.009). In the subgroups analyses, however, there was no significant differences between dexmedetomidine and controls/comparators when studies with confusion assessment method for ICU only (RD: -0.10 (-0.22, 0.02); P = 0.1) or midazolam as comparator only (RD: -0.26 (-0.60, 0.07); P = 0.12) were meta-analyzed. Dexmedetomidine use in the perioperative conditions or as ICU sedation is associated with lower risk of neurocognitive dysfunction. There can be some impact of neurocognitive assessment method, drug interactions, and clinical heterogeneity on the overall outcomes of this meta-analysis.

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Related in: MedlinePlus

Forest graph showing the results of a subgroup meta-analysis of the studies that utilized CAM-ICU versus all other neurocognitive assessment tools. CAM-ICU = cognitive assessment method for intensive care unit, DSST = digital symbol substitution test, ICDSC = intensive care delirium screening checklist, MCAT = Montreal cognitive assessment test, MMSE = minimental state examination, SAS = sedation–agitation score, SCWIT = Stroop color word interference test.
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Figure 4: Forest graph showing the results of a subgroup meta-analysis of the studies that utilized CAM-ICU versus all other neurocognitive assessment tools. CAM-ICU = cognitive assessment method for intensive care unit, DSST = digital symbol substitution test, ICDSC = intensive care delirium screening checklist, MCAT = Montreal cognitive assessment test, MMSE = minimental state examination, SAS = sedation–agitation score, SCWIT = Stroop color word interference test.

Mentions: In the subgroup analyses, however, there was no significant difference between dexmedetomidine and control/comparators when studies with CAM-ICU only (RD: −0.10 (−0.22, 0.02); P = 0.1; REM; Figure 4) or midazolam as comparator only (RD: −0.26 (−0.60, 0.07); P = 0.12; REM; Figure 5) were meta-analyzed. Outcomes of other subgroup analyses are presented in Table 3.


Neurocognitive dysfunction risk alleviation with the use of dexmedetomidine in perioperative conditions or as ICU sedation: a meta-analysis.

Li B, Wang H, Wu H, Gao C - Medicine (Baltimore) (2015)

Forest graph showing the results of a subgroup meta-analysis of the studies that utilized CAM-ICU versus all other neurocognitive assessment tools. CAM-ICU = cognitive assessment method for intensive care unit, DSST = digital symbol substitution test, ICDSC = intensive care delirium screening checklist, MCAT = Montreal cognitive assessment test, MMSE = minimental state examination, SAS = sedation–agitation score, SCWIT = Stroop color word interference test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554047&req=5

Figure 4: Forest graph showing the results of a subgroup meta-analysis of the studies that utilized CAM-ICU versus all other neurocognitive assessment tools. CAM-ICU = cognitive assessment method for intensive care unit, DSST = digital symbol substitution test, ICDSC = intensive care delirium screening checklist, MCAT = Montreal cognitive assessment test, MMSE = minimental state examination, SAS = sedation–agitation score, SCWIT = Stroop color word interference test.
Mentions: In the subgroup analyses, however, there was no significant difference between dexmedetomidine and control/comparators when studies with CAM-ICU only (RD: −0.10 (−0.22, 0.02); P = 0.1; REM; Figure 4) or midazolam as comparator only (RD: −0.26 (−0.60, 0.07); P = 0.12; REM; Figure 5) were meta-analyzed. Outcomes of other subgroup analyses are presented in Table 3.

Bottom Line: Many studies have reported the beneficial effects of dexmedetomidine on postoperative neurocognitive function but overall evidence is not as clear.Dexmedetomidine use in the perioperative conditions or as ICU sedation is associated with lower risk of neurocognitive dysfunction.There can be some impact of neurocognitive assessment method, drug interactions, and clinical heterogeneity on the overall outcomes of this meta-analysis.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Anesthesiology (BL, HW, CG), Jinan General Hospital, PLA Jinan Military Area Command, Jinan; and Department of Anesthesiology (HW), The People's Hospital of Zhangqiu, Zhangqiu, Shandong, China.

ABSTRACT
Many studies have reported the beneficial effects of dexmedetomidine on postoperative neurocognitive function but overall evidence is not as clear. We examined this conundrum by meta-analyzing studies that used dexmedetomidine in perioperative conditions or as intensive care unit (ICU) sedation and utilized reliable neurocognitive assessment tests. The literature search was undertaken across several electronic databases including EBSCO, Embase, Google Scholar, Ovid SP, PubMed, Scopus, and Web of Science. Literature search was carried out across several electronic databases and relevant studies were selected after following précised inclusion criteria. Meta-analysis of risk differences (RDs) was carried out and subgroup analyses were performed. Twenty studies were selected from which data of 2612 individuals were used. Initial dexmedetomidine dose was 0.68 ± 0.27 and maintenance dose was 0.54 ± 0.32 in the trials. Dexmedetomidine treatment was associated with significantly lower risk of postoperative/postanesthesia neurocognitive dysfunction both in comparison with saline-treated controls (RD [95% confidence interval, CI]: -0.17 (-0.30, -0.04); P = 0.008) and comparators (-0.16 [-0.28, -0.04]; P = 0.009). In the subgroups analyses, however, there was no significant differences between dexmedetomidine and controls/comparators when studies with confusion assessment method for ICU only (RD: -0.10 (-0.22, 0.02); P = 0.1) or midazolam as comparator only (RD: -0.26 (-0.60, 0.07); P = 0.12) were meta-analyzed. Dexmedetomidine use in the perioperative conditions or as ICU sedation is associated with lower risk of neurocognitive dysfunction. There can be some impact of neurocognitive assessment method, drug interactions, and clinical heterogeneity on the overall outcomes of this meta-analysis.

Show MeSH
Related in: MedlinePlus