Type of study: Randomized, controlled, double-blinded trial
Hypothesis: Incidence of new onset atrial fibrillation and incidence of delirium are reduced in patients given 24hrs of perioperative dexmedetomidine after cardiac surgery.
Methods: Multicenter, randomized, controlled trial at 6 US academic medical centers in subjects ages 18-85 undergoing cardiac surgery with cardiopulmonary bypass. Infusion was started before surgical incision at 0.1 μg/kg/h. At the end of bypass it was increased to 0.2μg/kg/h and to 0.4μg/kg/h at 24 hours postop.
Results: No significant differences in the incidence of atrial fibrillation or delirium between the groups.
Strengths:
Multicenter study
RCT
Good generalizability
Intention to treat analysis
Weaknesses:
Power calculated for atrial fibrillation outcome
Outcomes not specified to surgical procedure
Anesthetic management was not strictly controlled
IVF totals/medication totals were not reported (OR/ICU)
ICU management was not controlled
Study was stopped early due to expected futility
Key Point: Dexmedetomidine should not be infused in order to reduce atrial fibrillation or delirium in patients having cardiac surgery.