Table 1.
Characteristics of included studies
| Author (year) | Age, years | Patient number | Surgery type | Main outcomes | DEX intervention | Control infusion |
|---|---|---|---|---|---|---|
| Herr et al6 (2003) | 61.9 | 295 | CABG | No significant differences in RSS between groups during assisted ventilation (4.5, DEX vs 4.7, propofol; P=0.259) (P>0.05); no significant differences between the groups in median times to weaning, extubation and mean heart rates (P>0.05); DEX group required significantly less morphine (P<0.05) | 1.0 μg/kg induced, then 0.2–0.7 μg/kg/h maintained | Propofol used, but no detailed data |
| Corbett et al16 (2005) | 63.6 | 89 | CABG | Propofol Ramsay level 4.00 (95% CI 3.62–4.19) greater than DEX 3.67 (95% CI 3.00–4.15; P=0.021), the same incidence of fibrillation and delirium | 1 μg/kg induced, maintained by 0.4 μg/kg/h | Propofol: 0.2–0.7 μg/kg/h |
| Shehabi et al8 (2009) | 71.5 | 306 | On-pump cardiac surgerya | Delirium incidence was comparable between DEX 13 (8.6%) and morphine 22 (15.0%) (RR 0.571, 95% CI 0.256, 1.099, P=0.088); DEX showed no more benefits in sedation and pain levels and extubation time, except more earlier extubation and higher incidence of bradycardia | 0.1–0.7 μg/kg/h | Morphine: 10–70 μg/kg/h |
| Göksedef et al9 (2013) | 58 | 100 | CABG | AF, extubation time and mortality between two groups have no difference | 0.04 μg/kg/h | Placebo |
| Ren et al10 (2013) | 60 | 162 | CABG | The blood pressure, heart rate, postoperative arrhythmic events (including AF, ventricular tachycardia), duration of mechanical ventilation and ICU residence time in DEX were shorter than those in the control group (P<0.05) | 0.2–0.5 μg/kg/h | Propofol: 2–4 mg/kg/h |
| Karaman et al5 (2015) | 62.5 | 64 | CABG | DEX showed priority in extubation times, RSS and patient satisfaction; no difference for bradycardia and AF | 0.2–1.0 μg/kg/h | Propofol: 1.0–3.0 mg/kg/h |
| Djaiani et al7 (2016) | 72.7 | 183 | On-pump cardiac surgerya | POD was present in 16/91 (17.5%) and 29/92 (31.5%) patients in DEX and propofol groups, respectively (odds ratio, 0.46, 95% CI 0.23, 0.92, P=0.028) (P<0.05); onset and duration of POD show statistical difference | 0.4 μg/kg bolus followed by 0.2–0.7 μg/kg/h | Propofol: 25–50 μg/kg/min |
| Liu et al15 (2016) | 62.5 | 90 | On-pump cardiac surgerya | AF occurred in 6/44 patients (13.6%) in the DEX group compared to 16/44 patients (36.4%) in the propofol group (P=0.025); the DEX group had shorter length of ICU stay and high incidence of hypotension | 0.2–1.5 μg/kg/h | Propofol: 0.3–3 mg/kg/h |
| Liu et al17 (2017) | 53 | 61 | On-pump cardiac surgerya | Four hours after ICU admission, median changes in perfused small-vessel density and the De Backer score from baseline were significantly greater in the DEX group than in the propofol group (1.3 vs 0 mm/mm2, P=0.025; 0.9 vs −0.1/mm, P=0.005, respectively) | 0.2–1.5 μg/kg/h | Propofol: 5–50 μg/kg/min |
Note:
a
On-pump cardiac surgery including valve surgery or/and CABG.
Abbreviations: CABG, coronary artery bypass grafting; DEX, dexmedetomidine; ICU, intensive care unit; POD, postoperative delirium; RR, risk ratio; RSS, Ramsay Sedation Scores.