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• W3174986875 abstract "WE READ with great interest the recent systematic review and meta-analysis of Abowali et al.1Abowali HA Paganini M Enten G et al.Critical review and meta-analysis of postoperative sedation after adult cardiac surgery: Dexmedetomidine versus propofol.J Cardiothorac Vasc Anesth. 2021; 35: 1134-1142Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar The authors included 11 randomized controlled trials in their analyses and concluded that the use of postoperative dexmedetomidine sedation significantly reduced the time to extubation and intensive care unit (ICU) length of stay, but did not affect the duration of mechanical ventilation, length of hospitalization, and the incidence of postoperative delirium in adults after cardiac surgery. The authors also found a significant increase in the incidence of bradycardia and hypotension. We are grateful to the authors for providing an up-to-date summary regarding the use of dexmedetomidine for postoperative sedation in patients who underwent cardiac surgery. However, we have several concerns about the investigators’ methodology that may have erroneously influenced their conclusions. We believe that two studies2Sheikh TA Dar BA Akhter N et al.A comparative study evaluating effects of intravenous sedation by dexmedetomidine and propofol on patient hemodynamics and postoperative outcomes in cardiac surgery.Anesth Essays Res. 2018; 12: 555-560Crossref PubMed Google Scholar,3Shi C Jin J Qiao L et al.Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: A double-blinded, multi-center, randomized study.Clin Interv Aging. 2019; 14: 571-575Crossref PubMed Scopus (31) Google Scholar should not have been included in the meta-analysis. These studies appear to have been included based on the assumption that they compared the use of dexmedetomidine versus propofol in the context of postoperative sedation in adults after cardiac surgery. However, upon closer assessment of the article by Sheikh et al,2Sheikh TA Dar BA Akhter N et al.A comparative study evaluating effects of intravenous sedation by dexmedetomidine and propofol on patient hemodynamics and postoperative outcomes in cardiac surgery.Anesth Essays Res. 2018; 12: 555-560Crossref PubMed Google Scholar and after contacting the corresponding author, it is evident that these investigators only administered dexmedetomidine intraoperatively as opposed to postoperatively. This does not align with the author's inclusion criteria for their systematic review. Meanwhile, Shi et al3Shi C Jin J Qiao L et al.Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: A double-blinded, multi-center, randomized study.Clin Interv Aging. 2019; 14: 571-575Crossref PubMed Scopus (31) Google Scholar administered dexmedetomidine as an adjunctive therapy to propofol in their clinical trial. Upon admission to the ICU, Shi et al reported that all patients received propofol at 25-to-50 mg/kg/h for postoperative sedation. Because the use of dexmedetomidine as an adjunctive therapy was not described in the author's inclusion criteria, Shi et al also should not have been included in the meta-analyses. To investigate the impact of excluding Sheikh et al2Sheikh TA Dar BA Akhter N et al.A comparative study evaluating effects of intravenous sedation by dexmedetomidine and propofol on patient hemodynamics and postoperative outcomes in cardiac surgery.Anesth Essays Res. 2018; 12: 555-560Crossref PubMed Google Scholar and Shi et al3Shi C Jin J Qiao L et al.Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: A double-blinded, multi-center, randomized study.Clin Interv Aging. 2019; 14: 571-575Crossref PubMed Scopus (31) Google Scholar from the published meta-analysis, we replicated the authors’ meta-analyses using both the meta library (https://cran.r-project.org/web/packages/meta/) based on R, as well as the Comprehensive Meta-Analysis software (version 3.0, Biostat Inc.). Although the removal of the two ineligible studies did not considerably alter the results of the meta-analysis for many outcomes, such as the time to extubation, duration of mechanical ventilation, ICU length of stay, and hospital length of stay, it did affect the incidence of delirium. Specifically, the use of dexmedetomidine was associated with a significant reduction in postoperative incidence of delirium after the removal of the studies of Sheikh et al2Sheikh TA Dar BA Akhter N et al.A comparative study evaluating effects of intravenous sedation by dexmedetomidine and propofol on patient hemodynamics and postoperative outcomes in cardiac surgery.Anesth Essays Res. 2018; 12: 555-560Crossref PubMed Google Scholar and Shi et al3Shi C Jin J Qiao L et al.Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: A double-blinded, multi-center, randomized study.Clin Interv Aging. 2019; 14: 571-575Crossref PubMed Scopus (31) Google Scholar (random-effects odds ratio, 0.18, 95% confidence interval, 0.05-0.65), with a moderate level of heterogeneity (I2 = 52%) (Fig. 1). This result conflicts with the authors’ conclusions but is consistent with the findings of previous meta-analyses.4Tan JA Ho KM Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: A meta-analysis.Intensive Care Med. 2010; 36: 926-939Crossref PubMed Scopus (206) Google Scholar, 5Geng J Qian J Cheng H et al.The Influence of perioperative dexmedetomidine on patients undergoing cardiac surgery: A meta-analysis.PLoS One. 2016; 11e0152829Crossref PubMed Scopus (40) Google Scholar, 6Wu M Liang Y Dai Z et al.Perioperative dexmedetomidine reduces delirium after cardiac surgery: A meta-analysis of randomized controlled trials.J Clin Anesth. 2018; 50: 33-42Crossref PubMed Scopus (44) Google Scholar In addition to the erroneous inclusions, the data analysis also consists of other inaccuracies. For example, the pooled numerical result is not represented correctly in the forest plot on Figure 3B of the systematic review. Furthermore, it appears that a fixed-effects model was used to perform the meta-analysis for delirium incidence as opposed to a random-effects model (as indicated in the Methods section and on the forest plot). Based on our replication of the authors’ analysis including Sheikh et al2Sheikh TA Dar BA Akhter N et al.A comparative study evaluating effects of intravenous sedation by dexmedetomidine and propofol on patient hemodynamics and postoperative outcomes in cardiac surgery.Anesth Essays Res. 2018; 12: 555-560Crossref PubMed Google Scholar and Shi et al,3Shi C Jin J Qiao L et al.Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: A double-blinded, multi-center, randomized study.Clin Interv Aging. 2019; 14: 571-575Crossref PubMed Scopus (31) Google Scholar the use of dexmedetomidine would have been associated with a significant reduction in delirium incidence (odds ratio, 0.28, 95% confidence interval, 0.08-0.94) if the authors had performed the random-effects meta-analysis instead of the fixed-effects meta-analysis. Overall, because of the various inconsistencies in the authors’ inclusion criteria and data analysis, their meta-analysis could not have correctly established the effect of dexmedetomidine on postoperative delirium incidence in cardiac surgical patients. Our replication of the authors’ analyses, both with and without Sheikh et al2Sheikh TA Dar BA Akhter N et al.A comparative study evaluating effects of intravenous sedation by dexmedetomidine and propofol on patient hemodynamics and postoperative outcomes in cardiac surgery.Anesth Essays Res. 2018; 12: 555-560Crossref PubMed Google Scholar and Shi et al,3Shi C Jin J Qiao L et al.Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: A double-blinded, multi-center, randomized study.Clin Interv Aging. 2019; 14: 571-575Crossref PubMed Scopus (31) Google Scholar has shown that the postoperative use of dexmedetomidine is likely to be associated with a significant reduction in the incidence of postoperative delirium. None. Critical Review and Meta-Analysis of Postoperative Sedation after Adult Cardiac Surgery: Dexmedetomidine Versus PropofolJournal of Cardiothoracic and Vascular AnesthesiaVol. 35Issue 4PreviewTo evaluate reports from the published literature of all randomized clinical trials (RCT) comparing postoperative sedation with dexmedetomidine versus propofol in adult patients, after open cardiac surgery. Full-Text PDF" @default.
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• W3174986875 title "Current Evidence Demonstrates a Significant Reduction in the Incidence of Delirium With Postoperative Dexmedetomidine Versus Propofol Sedation" @default.
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