Myocardial protective effects of dexmedetomidine in patients undergoing cardiac surgery: A meta-analysis and systematic review

Zheng Gong, Li Ma, Yu-Lin Zhong, Jun Li, Jing Lv, Yu-Bo Xie, Zheng Gong, Li Ma, Yu-Lin Zhong, Jun Li, Jing Lv, Yu-Bo Xie

Abstract

Arrhythmias are the common complications following cardiac surgery and contribute to hemodynamic instability, cognitive impairment, thromboembolic events, and congestive heart failure. Prevention of atrial fibrillation following cardiac surgery reduces morbidity and among the many available preventive approaches dexmedetomidine shows many positive effects on cardiovascular stability. Even though many studies indicated the beneficial effects of dexmedetomidine, the power of the analysis and conclusion of these studies is rather weak due to relatively smaller number of patients in these studies. In the present meta-analysis, we included a large number of patients, both children and adults, undergoing cardiac surgery, to address the efficacy of dexmedetomidine. Several databases were searched to identify clinical studies comparing the efficacy of dexmedetomidine in myocardial protection in patients undergoing cardiac surgery. Cardiac function related parameters including heart rate, blood pressure, tachycardia, arrhthmias, and bradycardia were measured. In accordance with the selection criteria, a total of 18 studies published between 2003 and 2016, with a total of 19,225 patients were included in the present meta-analysis. Dosage of dexmedetomidine was in the range of 0.5-1 µg/kg body weight loading followed by continuous infusion at a rate of 0.2-0.7 µg/kg/h. Dexmedetomidine treatment was found to lower heart rate, systolic blood pressure, incidence of tachycardia and arrhythmias in both adult and pediatric patients, but elevated the risk of bradycardia. In conclusion, results of this meta-analysis indicate that dexmedetomidine is an efficacious cardioprotective drug in adults and children undergoing cardiac surgery.

Keywords: cardiac surgery; dexmedetomidine.

Figures

Figure 1.
Figure 1.
Study selection flow chart.
Figure 2.
Figure 2.
Effect of dexmedetomidine treatment on heart rate in patients with cardiac surgery. Forest plot of mean difference analyzed by inverse variance (IV) analysis in random-effect model at 95% confidence intervals (CI).
Figure 3.
Figure 3.
Effect of dexmedetomidine treatment on systolic blood pressure in patients with cardiac surgery. Forest plot of mean difference analyzed by inverse variance (IV) analysis in random-effect model at 95% confidence intervals (CI).
Figure 4.
Figure 4.
Prevention of tachycardia by dexmedetomidine in patients undergoing cardiac surgery compared to control patients. Forest plot of odds ratio, analyzed by Mantel-Haenszel statistics in the random-effect model.
Figure 5.
Figure 5.
Prevention of atrial fibrillation by dexmedetomidine in patients undergoing cardiac surgery compared to control patients. Forest plot of odds ratio, analyzed by Mantel-Haenszel statistics in the random-effect model.
Figure 6.
Figure 6.
Increased incidence of bradycardia in patients undergoing cardiac surgery treated with dexmedetomidine compared to control patients. Forest plot of odds ratio, analyzed by Mantel-Haenszel statistics in the random-effect model.

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