The evolving clinical use of dexmedetomidine

In patients having cardiac and non-cardiac surgery, new-onset postoperative atrial fibrillation and postoperative delirium have been associated with several adverse long-term outcomes, including increased cardiovascular, renal, and cerebral complications, worsened postoperative cognitive function, increased mortality, longer length of stay in hospital, and increased medical costs. 1 Dobrev D Aguilar M Heijman J Guichard JB Nattel S Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019; 16: 417-436 Crossref PubMed Scopus (188) Google Scholar , 2 Bilotta F Pizzichetta F Fiorani L Paoloni FP Delfini R Rosa G Risk index for peri-operative atrial fibrillation in patients undergoing open intracranial neurosurgical procedures. Anaesthesia. 2009; 64: 503-507 Crossref PubMed Scopus (10) Google Scholar , 3 Aldecoa C Bettelli G Bilotta F et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017; 34: 192-214 Crossref PubMed Scopus (506) Google Scholar Identifying effective therapies and modifiable factors that might reduce the incidence of postoperative atrial fibrillation and postoperative delirium is paramount. Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trialDexmedetomidine infusion, initiated at anaesthetic induction and continued for 24 h, did not decrease postoperative atrial arrhythmias or delirium in patients recovering from cardiac surgery. Dexmedetomidine should not be infused to reduce atrial fibrillation or delirium in patients having cardiac surgery. Full-Text PDF