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.

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