id_847. EFFICACY OF DEXMEDETOMIDINE IN PREVENTING POSTOPERATIVE DELIRIUM IN PATIENTS UNDERGOING BRAIN SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS
Eloísa Bittencurt Thomaz de Assis2, Maria Angélica Otero de Melo dos Reis1, Harshada Kalaiarasan Swamy2, Baltazar César Miranda Matos1, Marcio Yuri Ferreira3, Netanel Ben-Shalom3, Juliana Estima Rissi Polverini4, Allan Dias Polverini5
1 Faculty of Medicine, Universidad Nacional de Rosario, Rosario, Argentina
2 Faculty of Medicine, Baltic Federal University, Kaliningrad, Russian Federation
3 Department of Neurosurgery, Northwell Health Hospital, New York, United States of America
4 Department of Anaesthesiology, Barretos Cancer Hospital, SP, Brazil
5 Neurosurgical Oncology Division, Barretos Cancer Hospital, SP, Brazil
INTRODUCTION: Dexmedetomidine (DEX) is a selective α2-adrenergic receptor agonist widely used for its sedative and neuroprotective properties. Patients undergoing brain surgery are at increased risk of postoperative delirium (POD), a complication associated with poorer neurological outcomes.
AIM(S): To evaluate the efficacy and safety of DEX for POD prevention in adult neurosurgical patients through a systematic review and meta-analysis.
METHOD(S): PubMed, Embase, Scopus, and Web of Science were searched from inception to January 2025 and updated in April 2025, in accordance with PRISMA guidelines. Randomised controlled trials assessing DEX for POD prevention in adult patients undergoing brain surgery were included. Risk of bias was evaluated using standard tools, and meta-analysis was performed using Review Manager 5.4.1. The review was prospectively registered in PROSPERO (CRD42025649703).
RESULTS: Five randomised controlled trials comprising 752 adult patients were included. DEX was administered with a loading dose of 0.5–1 μg/kg over 10 minutes, followed by maintenance infusions of 0.1–0.5 μg/kg/hour, delivered intraoperatively and/or during the early postoperative period. DEX significantly reduced the incidence of POD (RR 0.47; 95% CI 0.35–0.63; p < 0.00001), representing a 53% relative risk reduction, with no heterogeneity (I² = 0%). In subgroup analyses, brain tumour resection (n = 319) showed a comparable reduction (RR 0.47; 95% CI 0.33–0.68; p < 0.0001). Similar effects were observed in mixed cranial surgery populations (n = 322; RR 0.47; 95% CI 0.29–0.76; p = 0.002), also without heterogeneity. Adverse events were comparable between groups and were generally mild and manageable with standard interventions.
CONCLUSIONS: DEX was associated with a consistent and clinically meaningful reduction in POD in adult patients undergoing brain surgery. Further studies are required to define optimal dosing strategies and the timing of administration.