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July08

Posted by:John Ellis
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A retrospective study published in Circulation suggest that dexmedetomidine after cardiac surgery improves outcome:

Dexmedetomidine use significantly reduced:

  • postoperative in-hospital (1.23% versus 4.59%; adjusted odds ratio, 0.34; 95% confidence interval, 0.192-0.614; P<0.0001),
  • 30-day (1.76% versus 5.12%; adjusted odds ratio, 0.39; 95% confidence interval, 0.226-0.655; P<0.0001), and
  • 1-year (3.17% versus 7.95%; adjusted odds ratio, 0.47; 95% confidence interval, 0.312-0.701; P=0.0002) mortality.

Perioperative dexmedetomidine therapy also reduced the risk of :

  • overall complications (47.18% versus 54.06%; adjusted odds ratio, 0.80; 95% confidence interval, 0.68-0.96; P=0.0136) and
  • delirium (5.46% versus 7.42%; adjusted odds ratio, 0.53; 95% confidence interval, 0.37-0.75; P=0.0030).

The study suffers from the usual problems of retrospective studies – despite the use of propensity scores and mutlivariable logistic regression, we cannot be sure that there aren’t unknown differences between patients who received and didn’t receive the drug.

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Do you use alpha 2 agonists in your practice?  If so, what are indications?  Contraindications?




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