Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials

Abstract Background Dexmedetomidine's influence on postoperative delirium (POD) in adult surgical patients remains controversial. We aimed to analyse whether dexmedetomidine could decrease POD incidence in this population and to address the dependency on dexmedetomidine administration timing and patients' age. Methods We used random-effects modelled meta-analysis, trial sequential analysis, and followed Cochrane methodology with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). PubMed and Cochrane library were searched up to July 2017 for randomised controlled trials that analysed POD incidence of adult surgical patients (age ≥18 yr) after dexmedetomidine administration. Results Eighteen studies (comprising 3309 patients) were included and showed decreased risk of POD with dexmedetomidine for entire adult surgical population [odds ratio (OR) 0.35; 95% confidence interval (CI) 0.24–0.51)], with firm evidence from trial sequential analysis. Pre-specified subgroup analyses confirmed this result with firm evidence for cardiac and non-cardiac surgical patients, (OR 0.41; 95% CI 0.26–0.63) and (OR 0.33; 95% CI 0.18–0.59), respectively. We also revealed firm evidence for a reduction of POD, if dexmedetomidine is administered during postoperative period (OR 0.30; 95% CI 0.21–0.44), in patients aged Conclusion Dexmedetomidine may reduce POD incidence for adult cardiac and non-cardiac surgical patients. The optimal dose and timing of dexmedetomidine and influence on other outcomes or particular patient populations with risk factors warrants further studies. Clinical trial registration PROSPERO: CRD42017072380.