Intraoperative dexmedetomidine to prevent postoperative delirium: in search of the magic bullet

Excerpt

Agitation and delirium are important targets for quality improvement across inpatient healthcare settings because of the time- and resource-intensive nature of the screening, diagnosis, and management processes. In the general patient population, no prophylactic pharmacologic treatment has shown widespread effectiveness in preventing delirium. Several studies have failed to find a magic pharmacologic bullet for preventing delirium—ketamine and haloperidol have recently failed to impress.1,2 Dexmedetomidine is an attractive pharmacologic option because of its biologic plausibility in modifying several known contributors to delirium, including attenuating inflammatory mediators and catecholamines, providing analgesia, reducing delirium-inducing medications, and promoting natural sleep-wake cycles, among other plausible neuroprotective mechanisms. Data on postoperative delirium after intraoperative dexmedetomidine administration are conflicting, and the diverse mechanisms by which it may act have prompted trials in a variety of populations, with a variety of doses and administration schema. If providing dexmedetomidine intraoperatively to a diverse group of patients otherwise receiving usual care has not been effective,3 could its use in a highly protocolized, homogenous setting reveal an effect? …