Intraoperative dexmedetomidine reduces postoperative sleep disturbance in older adults undergoing major abdominal surgery: a single-center, randomized, double-blind, placebo-controlled trial.

Summary

In a single-center, randomized, double-blind trial of 203 older adults undergoing major abdominal surgery, intraoperative dexmedetomidine (0.3 or 0.6 μg/kg/h) reduced first-night postoperative sleep disturbance versus saline (absolute risk reductions ~45–54%). Benefits extended to night 2 and early recovery quality without increasing hypotension, bradycardia, delirium, or 30-day mortality.

Key Findings

• Dexmedetomidine reduced first-night PSD incidence from 65.7% (saline) to 20.6% (low dose) and 11.8% (high dose).
• Benefits persisted on night 2 and improved early recovery quality (higher QoR-15).
• No increase in hypotension, bradycardia, delirium, or 30-day mortality; actigraphy suggested longer total sleep time.

Clinical Implications

Consider intraoperative dexmedetomidine infusion (0.3–0.6 μg/kg/h) to reduce first-night postoperative sleep disturbance in older adults undergoing major abdominal surgery, with routine hemodynamic monitoring. Larger multicenter trials should confirm generalizability and long-term outcomes.

Limitations

• Single-center study limits generalizability; short-term outcomes predominate.
• Actigraphy performed in a small exploratory subset (n≈20/group).

Future Directions

Multicenter pragmatic trials to validate effectiveness across diverse surgical populations, dose optimization, and assessment of long-term sleep, cognitive, and recovery outcomes.