Dexmedetomidine vs morphine and midazolam in the prevention and treatment of delirium after adult cardiac surgery; a randomized, double-blinded clinical trial

Tamer M Abdel Azeem, Nahed E Yosif, Adel M Alansary, Ibrahim Mamdouh Esmat, Ahmed K Mohamed, Tamer M Abdel Azeem, Nahed E Yosif, Adel M Alansary, Ibrahim Mamdouh Esmat, Ahmed K Mohamed

Abstract

Background: The aim of this clinical study was to evaluate the efficacy of neurobehavioral, hemodynamics and sedative characteristics of dexmedetomidine compared with morphine and midazolam-based regimen after cardiac surgery at equivalent levels of sedation and analgesia in improving clinically relevant outcomes such as delirium.

Methods: Sixty patients were randomly allocated into one of two equal groups: group A = 30 patients received dexmedetomidine infusion (0.4-0.7 μg/kg/h) and Group B = 30 patients received morphine in a dose of 10-50 μg/kg/h as an analgesic with midazolam in a dose of 0.05 mg/kg up to 0.2 mg/kg as a sedative repeated as needed. Titration of the study medication infusions was conducted to maintain light sedation (Richmond agitation-sedation scale) (-2 to +1). Primary outcome was the prevalence of delirium measured daily through confusion assessment method for intensive care.

Results: Group A was associated with shorter length of mechanical ventilation, significant shorter duration of intensive care unit (ICU) stay (P = 0.038), and lower risk of delirium following cardiac surgery compared to Group B. Group A showed statistically significant decrease in heart rate values 4 h after ICU admission (P = 0.015) without significant bradycardia. Group A had lower fentanyl consumption following cardiac surgery compared to Group B.

Conclusion: Dexmedetomidine significantly reduced the length of stay in ICU in adult cardiac surgery with no significant reduction in the incidence of postoperative delirium compared to morphine and midazolam.

Keywords: Dexmedetomidine; midazolam; morphine; postoperative delirium.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Group A protocol
Figure 2
Figure 2
Flowchart of patients
Figure 3
Figure 3
Length of stay in intensive care unit (days). *Denotes significant difference. Lines are mean length of stay and error bars are standard deviation
Figure 4
Figure 4
Changes in heart rate (beat/min). HR 1: On admission, HR2: After 4 h, HR3: After 8 h, HR 4: After 12 h. *Denotes significant difference
Figure 5
Figure 5
Changes in systolic blood pressure (mmHg). SBP1: On admission. SBP2: After 4 h. SBP3: After 8 h. SBP 4: After 12 h
Figure 6
Figure 6
Changes in diastolic blood pressure (mmHg). DBP1: On admission. DBP2: After 4 h. DBP3: After 8 h. DBP 4: After 12 h

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