Postoperative delirium (POD) is a major complication following surgery and is considered the most common complication among older adults following cardiac surgery; with up to 87% of patients being affected (Whitlock, Vannucci, & Avidan, 2011). Dexmedetomidine, a highly selective α2 agonist, inhibits the release of norepinephrine presynaptically causing analgesia and inhibits central nervous system stimulation in the postsynaptic neurons causing decreased blood pressure and heart rate; together, contributing to the effects of analgesia, anesthesia, and sedation (Naaz & Ozair, 2014). The purpose of this systematic review was to analyze the current literature and examine the effects of dexmedetomidine on POD in the adult cardiac surgical population. A comprehensive literature review was completed using CINAHL, PubMed, and Medline focusing on the pathology of postoperative delirium, the physiology of cardiac surgery, and the pharmacodynamics of dexmedetomidine. Guidelines set forth by PRISMA and Inouye and Charpentier’s multifactorial model were utilized to assist in the identification of eligible studies. Study analysis was completed by creating study specific and data outcome tables. Critical appraisal of individual RCTs was performed utilizing the Critical Appraisal Skills Programme (CASP) checklist. A cross study analysis table was also created comparing the results of all eligible studies against one another. The findings of this systematic review determined that in the adult cardiac surgical population, dexmedetomidine was associated with a decreased incidence of POD; however, the results for time to extubation, ICU LOS (length of stay), and hospital LOS varied amid the studies examined.
Outcome Reporting in Cardiac Surgery Trials: Systematic Review and Critical Appraisal