Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Effect of Intraoperative Dexmedetomidine Administration on Postoperative Delirium Scores During the First 72 Hours: A Randomized Controlled Trial

Document Type : Original Article

Authors

Sima Miraghaei 1
Mansour Rezaei 2

1 Assistant Professor of Anesthesiology, Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Associate Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz, Iran

10.5281/zenodo.22059659
Abstract
Introduction: Postoperative delirium is a frequent complication associated with prolonged recovery, increased morbidity, and higher healthcare costs. Dexmedetomidine may reduce delirium through its sedative, analgesic-sparing, and sympatholytic effects, although evidence remains inconsistent. This randomized controlled trial aimed to evaluate the effect of intraoperative dexmedetomidine administration on postoperative delirium scores during the first 72 hours.

Material and methods: In this double-blind, randomized controlled trial conducted at Imam Reza Hospital, 50 surgical patients were allocated (1:1) to receive either intraoperative dexmedetomidine (0.5 µg/kg bolus, then 0.2–0.5 µg/kg/h infusion) or 0.9% normal saline. Postoperative delirium was evaluated during the first 72 hours using the Confusion Assessment Method (CAM/CAM-S).

Results: Across the first 72 postoperative hours, the dexmedetomidine group showed consistently lower delirium severity and incidence than controls, with the greatest separation at 24–48 hours; delirium scores peaked early and then declined in both groups, but remained lower with dexmedetomidine at every assessment (all time points: P<0.05). In parallel, the dexmedetomidine group had lower intraoperative heart rate and slightly lower mean arterial pressure, along with significantly lower postoperative VAS pain scores from 1 to 24 hours (all comparisons: P<0.05).

Conclusion: Intraoperative dexmedetomidine appears to reduce early postoperative delirium burden while improving analgesia and maintaining acceptable hemodynamic stability. These findings support its role as a useful perioperative adjunct, likely through attenuation of surgical stress, sympathetic activation, and pain-related neurocognitive disruption.

Graphical Abstract

Effect of Intraoperative Dexmedetomidine Administration on Postoperative Delirium Scores During the First 72 Hours: A Randomized Controlled Trial

Keywords

dexmedetomidine
postoperative delirium
randomized controlled trial
postoperative pain
Subjects
[1]       Albert, M. S., Levkoff, S. E., Reilly, C., Liptzin, B., Pilgrim, D., Cleary, P. D., Evans, D., & Rowe, J. W. (1992). The delirium symptom interview: An interview for the detection of delirium symptoms in hospitalized patients. Journal of Geriatric Psychiatry and Neurology, *5*(1), 14–21.
[2]       American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. (2015). Postoperative delirium in older adults: Best practice statement from the American Geriatrics Society. Journal of the American College of Surgeons, *220*(2), 136–148.e1.
[3]       Avidan, M. S., Searleman, A. C., Storandt, M., Barnett, K., Vannucci, A., Saager, L., Xiong, C., Grant, E. A., Kaiser, D., Morris, J. C., & Evers, A. S. (2009). Long-term cognitive decline in older subjects was not attributable to noncardiac surgery or major illness. Anesthesiology, *111*(5), 964–970.
[4]       Brown, C. H., IV, Laflam, A., Max, L., Wyrobek, J., Neufeld, K. J., Kebaish, K. M., Cohen, N. H., & Hogue, C. W. (2016). The impact of delirium after cardiac surgical procedures on postoperative resource use. The Annals of Thoracic Surgery, *101*(5), 1663–1669.
[5]       Bryson, G. L., Wyand, A., Wozny, D., Rees, L., Taljaard, M., & Nathan, H. (2011). A prospective cohort study evaluating associations among delirium, postoperative cognitive dysfunction, and apolipoprotein E genotype following open aortic repair. Canadian Journal of Anaesthesia, *58*(3), 246–255.
[6]       Cormack, F., Shipolini, A., Awad, W. I., Richardson, C., Rajani, R., & Taggart, D. P. (2012). A meta-analysis of cognitive outcome following coronary artery bypass graft surgery. Neuroscience & Biobehavioral Reviews, *36*(9), 2118–2129.
[7]       Deiner, S., & Silverstein, J. H. (2009). Postoperative delirium and cognitive dysfunction. British Journal of Anaesthesia, *103*(Suppl. 1), i41–i46.
[8]       Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R. (2016). Dexmedetomidine vs propofol sedation reduces delirium after cardiac surgery: A randomized controlled trial. Anesthesiology, *124*(2), 362–368.
[9]       Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., Hart, R. P., & Dittus, R. S. (2001). Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA, *286*(21), 2703–2710.
[10]    Evered, L., Scott, D. A., Silbert, B., & Maruff, P. (2011). Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesthesia & Analgesia, *112*(5), 1179–1185.
[11]    Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, *12*(3), 189–198.
[12]    Hipp, D. M., & Ely, E. W. (2012). Pharmacological and nonpharmacological management of delirium in critically ill patients. Neurotherapeutics, *9*(1), 158–175.
[13]    Hudetz, J. A., Patterson, K. M., Byrne, A. J., Pagel, P. S., & Warltier, D. C. (2009). Postoperative delirium is associated with postoperative cognitive dysfunction at one week after cardiac surgery with cardiopulmonary bypass. Psychological Reports, *105*(3, Pt. 1), 921–932.
[14]    Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, *354*(11), 1157–1165.
[15]    Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: The Confusion Assessment Method—A new method for detection of delirium. Annals of Internal Medicine, *113*(12), 941–948.
[16]    Mann, C., Pouzeratte, Y., Boccara, G., Peccoux, C., Vergne, C., Brunat, G., Domergue, J., Millat, B., & Colson, P. (2000). Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology, *92*(2), 433–441.
[17]    Mo, Y., & Zimmermann, A. E. (2013). Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. Annals of Pharmacotherapy, *47*(6), 869–876.
[18]    Moller, J. T., Cluitmans, P., Rasmussen, L. S., Houx, P., Rasmussen, H., Canet, J., Rabbitt, P., Jolles, J., Larsen, K., Hanning, C. D., Langeron, O., Johnson, T., Lauven, P. M., Kristensen, P. A., Biedler, A., van Beem, H., Fraidakis, O., Silverstein, J. H., Beneken, J. E. W., ... & Gravenstein, J. S. (1998). Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study: International Study of Post-Operative Cognitive Dysfunction. The Lancet, *351*(9106), 857–861.
[19]    Monk, T. G., Saini, V., Weldon, B. C., & Sigl, J. C. (2005). Anesthetic management and one-year mortality after noncardiac surgery. Anesthesia & Analgesia, *100*(1), 4–10.
[20]    Monk, T. G., Weldon, B. C., Garvan, C. W., Dede, D. E., van der Aa, M. T., Heilman, K. M., & Gravenstein, J. S. (2008). Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology, *108*(1), 18–30.
[21]    Müller, A., Lachmann, G., Wolf, A., Mörgeli, R., Weiss, B., & Spies, C. (2016). Peri- and postoperative cognitive and consecutive functional problems of elderly patients. Current Opinion in Critical Care, *22*(4), 406–411.
[22]    Riker, R. R., Shehabi, Y., Bokesch, P. M., Ceraso, D., Wisemandle, W., Koura, F., Whitten, P., Margolis, B. D., Byrne, D. W., Ely, E. W., & Rocha, M. G. (2009). Dexmedetomidine vs midazolam for sedation of critically ill patients: A randomized trial. JAMA, *301*(5), 489–499.
[23]    Saczynski, J. S., Marcantonio, E. R., Quach, L., Fong, T. G., Gross, A., Inouye, S. K., & Jones, R. N. (2012). Cognitive trajectories after postoperative delirium. New England Journal of Medicine, *367*(1), 30–39.
[24]    Schenning, K. J., & Deiner, S. G. (2015). Postoperative delirium in the geriatric patient. Anesthesiology Clinics, *33*(3), 505–516.
[25]    Selnes, O. A., Gottesman, R. F., Grega, M. A., Baumgartner, W. A., Zeger, S. L., & McKhann, G. M. (2012). Cognitive and neurologic outcomes after coronary-artery bypass surgery. New England Journal of Medicine, *366*(3), 250–257.
[26]    Shehabi, Y., Grant, P., Wolfenden, H., Hammond, N., Bass, F., Campbell, M., & Chen, J. (2009). Prevalence of delirium with dexmedetomidine compared with morphine-based therapy after cardiac surgery: A randomized controlled trial (Dexmedetomidine Compared to Morphine—DEXCOM Study). Anesthesiology, *111*(5), 1075–1084.
[27]    Su, X., Meng, Z. T., Wu, X. H., Cui, F., Li, H. L., Wang, D. X., Zhu, X., Zhu, S. N., Maze, M., & Ma, D. (2016). Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: A randomised, double-blind, placebo-controlled trial. The Lancet, *388*(10054), 1893–1902.
[28]    Weintraub, S., Salmon, D., Mercaldo, N., Ferris, S., Graff-Radford, N. R., Chui, H., Cummings, J., DeCarli, C., Foster, N. L., Galasko, D., Peskind, E., Dietrich, W., Beekly, D. L., Kukull, W. A., & Morris, J. C. (2009). The Alzheimer’s Disease Centers’ Uniform Data Set (UDS): The neuropsychologic test battery. Alzheimer Disease & Associated Disorders, *23*(2), 91–101.
Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)
Volume 2, Issue 6
November and December 2026
Pages 518-526

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