SynthesisFrontiers in neurology2026
Efficacy and hemodynamic safety of perioperative dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials.
Synthesis in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Postoperative delirium (POD) is a common and clinically important complication after cardiac surgery in older adults. We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and hemodynamic safety of perioperative dexmedetomidine for POD prevention in older adults undergoing cardiac surgery. Methods: We searched PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from inception through July 12th, 2026 for RCTs comparing perioperative dexmedetomidine with placebo or alternative sedative /analgesic regimens in elderly patients aged 60 years or older, or in extractable elderly subgroups, undergoing cardiac surgery. Primary outcomes were POD incidence and delirium duration. Secondary outcomes included length of intensive care unit (ICU) stay, length of hospital stay, and the risk of bradycardia and hypotension. Results: Fifteen RCTs involving 3,274 patients were included. Perioperative dexmedetomidine was associated with a lower incidence of POD (Risk Ratio [RR] 0.70, 95% Confidence Interval [CI] 0.56 to 0.86, Conclusion: Perioperative dexmedetomidine may reduce POD incidence in selected older cardiac surgery patients, particularly when compared with selected active sedative or analgesic regimens. However, the certainty of evidence was moderate, and the effect was less clear in saline/placebo-controlled trials. Evidence for delirium duration was based on few affected patients, showed substantial heterogeneity, and should not drive the main clinical conclusion. Dexmedetomidine increased reported bradycardia, and clinical use should be individualized with careful hemodynamic monitoring. Systematic review registration: https://osf.io/f6nwu.
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