Effect of intraoperative dexmedetomidine on postoperative mental health in cardiac surgery: a randomized controlled trial.

Summary

In a blinded randomized trial of 200 cardiac surgery patients, intraoperative dexmedetomidine reduced 7-day postoperative depression (PHQ-9), delirium, anxiety, sleep disturbance, and movement pain, and improved EQ-5D-5L scores versus placebo. Benefits were not sustained at 30 days.

Key Findings

• Dexmedetomidine reduced 7-day depression (11% vs 31%; aRR 0.29) and delirium (5% vs 19%; aRR 0.17) compared with placebo.
• Anxiety, sleep disturbance, and movement pain were also significantly lower at day 7; EQ-5D-5L quality-of-life was higher.
• No significant between-group differences persisted at 30 days for mental health, sleep, pain, or quality of life.

Clinical Implications

Consider dexmedetomidine as part of intraoperative anesthesia for cardiac surgery to reduce early postoperative depression, delirium, anxiety, and pain, while planning follow-up strategies since benefits may wane by 30 days.

Limitations

• Single time-window dosing regimen; dose-response and duration effects not explored
• Benefits attenuated by 30 days; mechanisms of transient effect not elucidated

Future Directions

Test perioperative dexmedetomidine protocols optimizing dose and duration, combined with postoperative mental health interventions, and evaluate longer-term cognitive and affective outcomes.