Efficacy of Dexmedetomidine in Preventing Postoperative Delirium in Patients Undergoing Brain Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

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Abstract

Introduction: Dexmedetomidine (DEX), a selective alpha-2 adrenergic receptor agonist, is widely used in various surgical settings, including cardiac and general surgeries, for its sedative, analgesic, and neuroprotective properties. Patients undergoing brain surgery are particularly susceptible to postoperative delirium (POD). Given the established benefits of dexmedetomidine in other surgical fields, its potential to mitigate delirium in neurosurgery warrants focused investigation. Methods A systematic search of PubMed, Embase, Scopus, and Cochrane databases was conducted from inception to January 2025 and updated in April 2025 per PRISMA guidelines. Risk of bias was assessed, and a meta-analysis was performed using Review Manager 5.4.1. This systematic review and meta-analysis included five randomised controlled trials that met the inclusion criteria and evaluated the efficacy of DEX in preventing postoperative delirium among adult patients undergoing brain surgery. Results A total of 752 patients were analysed, with DEX administered with a loading dose ranging from 0.5 to 1 µg/kg over 10 minutes, followed by a maintenance infusion rate of 0.1 to 0.5 µg/kg/hour during the surgical procedure. The pooled risk ratio (RR) for POD with DEX was 0.47 (95% CI: 0.35–0.63; p < 0.00001); this corresponds to a 53% reduction in the risk of postoperative delirium, with no observed heterogeneity (χ² = 2.09, df = 4, p = 0.72; I² = 0%), indicating a consistent effect size across trials. In the brain-tumour resection subgroup (n = 319; 160 DEX, 159 control), DEX conferred a 53% risk reduction (RR 0.47; 95% CI 0.33–0.68; Z = 3.98; p < 0.0001; χ² = 0.13, df = 1, p = 0.72; I² = 0%). In the various cranial‑surgery subgroups (n = 322; 162 DEX, 160 control), DEX was associated with a 53% risk reduction (RR 0.47; 95% CI 0.29–0.76; Z = 3.10; p = 0.002; τ² = 0.00, χ² = 1.99, df = 2, p = 0.37; I² = 0%). With no observed heterogeneity in both subgroups. The incidence of adverse events was comparable between the DEX and control groups, and the reported adverse effects were generally mild and effectively managed with standard interventions. Conclusion This meta-analysis demonstrates that in the included studies DEX was associated with a significant reduction in postoperative delirium risk in brain surgery patients, suggesting potential benefits for POD control. However, further studies are needed to optimise dosing and the timing of application.

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