Effects of Dexmedetomidine on Cardioprotection and Other Postoperative Complications in Elderly Patients after Cardiac and Non-Cardiac Surgerie

BACKGROUND After cardiac and non-cardiac surgeries, elderly patients have a high probability of developing cardiac complications and postoperative delirium. Although several clinical trials have investigated whether perioperative intravenous dexmedetomidine can protect the heart and reduce postoperative complications such as delirium in elderly patients, the obtained results have been inconsistent. We conducted a meta-analysis to investigate the effects of dexmedetomidine on cardioprotection and other postoperative complications in elderly patients undergoing cardiac or non-cardiac surgery.AIM To investigate the effects of dexmedetomidine on cardiac complications and delirium in elderly patients undergoing cardiac or non-cardiac surgery.METHODS The Pub Med, Cochrane Library, web of science, and other sources were comprehensively searched for all randomized controlled trials published before May 2021 that investigated the efficacy of dexmedetomidine in the prevention of cardiac and postoperative delirium（POD）.RESULTS In total, 18 studies involving 1025 patients were included in the meta-analysis. Intravenous dexmedetomidine significantly reduced cardiac troponin I（c Tn I） and the inflammatory factor tumor necrosis factor-α（TNF-α） was comparable to the control group. Dexmedetomidine also reduced the POD and mortality rates. However, patients in the dexmedetomidine group were more likely to have a decreased heart rate（within the normal range） and hypotension during dexmedetomidine administration than those in the control group. There was no difference in the occurrence of myocardial infarction, bradycardia, or stroke between the two groups. Dexmedetomidine significantly shortened the time to extubate; however, it did not shorten the length of stay in the intensive care unit.CONCLUSION The administration of dexmedetomidine during cardiac and non-cardiac surgeries can provide myocardial protection by inhibiting inflammation and c Tn I, which may be beneficial for the rapid recovery of patients. Meanwhile, the administration of dexmedetomidine reduced the incidence of POD and decreased mortality（in-hospital）.