Introduction
Perioperative medicine, which aims to enhance high-quality postoperative recovery of patients, refers to the entire period from the beginning of the patient’s surgical treatment to the end, and can generally be divided into three phases: preoperative preparation, intraoperative operation and postoperative recovery.1,2 Dexmedetomidine, as a potent and highly selective α-2 adrenoceptor agonist with sedative, analgesic, anxiolytic, and sympatholytic effects, has been widely used in perioperative medicine.3,4 Several clinical studies have demonstrated that dexmedetomidine can prevent surgery-related adverse events and enhance patient outcomes, including reduced preoperative anxiety, lessened surgical stress, improved immune function and minimized postoperative complications.5,6 Unlike other sedative drugs, dexmedetomidine can produce a state of unconsciousness like natural sleep, which allows for easy arousal and co-operation with minimal inhibition of respiratory function.3 Dexmedetomidine is also a potential adjunct in peripheral nerve block, promoting better postoperative analgesia and prolonging the effects of local anesthesia.7,8
As a pediatric premedication, dexmedetomidine has advantages with anxiolysis, ease of separation from parents, improving perioperative sedation and analgesia and reducing postoperative agitation.9–11 Additionally, dexmedetomidine has been shown to reduce myocardial oxygen consumption by decreasing certain physiological parameters, thereby reducing the occurrence of postoperative cardiac complications such as myocardial ischemia. This reduction in complications has been associated with an improvement in the 5-year survival rate of patients who underwent cardiac surgery.12 Furthermore, the use of prophylactic low-dose dexmedetomidine has also been found to significantly decrease the occurrence of delirium during the first 7 days after non-cardiac surgery in intensive care units.13 From the above, it is evident that numerous papers related to dexmedetomidine research have been published in international journals. Consequently, a bibliometric analysis is essential to better comprehend the current state of research and development trends in this field, providing a systematic organization and in-depth analysis of research dynamics.
Bibliometric analysis is a method of assessing the quality of literature by using mathematical and statistical techniques to analyze the literature retrospectively and look for data correlations.14,15 Bibliometric analysis can help researchers to understand the latest advances, hotspots and predict future trends in this cutting-edge field and help in choosing the direction of research.16 In this study, the bibliometric analysis was implemented to analyze the use of dexmedetomidine in perioperative medicine, quantifying essential information and identifying the most influential academic publications, trends and hotspots to provide new ideas for subsequent research.
Materials and Methods
Search Strategy and Data Collection
The related literature published before 31 December 2022 was obtained from Science Citation Index Expanded (SCI-E) databases. To eliminate any bias derived from the database updates, we collected all comprehensive publications on the same day. The search strategies were set as follows: TS = (Post$operat* OR pre$operat* OR intra$operat* OR peri$operat* OR Post$surgical OR pre$surgical) AND TI = (Dexmedetomidine). All retrieved records were exported in the “Plain Text File” format with “Record Content” selected “Full Record and Cited References”. Only articles and reviews with language restriction to English were extracted for further analysis. The detailed search flow and results are shown in Figure 1. Our bibliometric analysis included studies investigating perioperative dexmedetomidine use across all age groups, from pediatric to geriatric populations, without age restrictions.
Bibliometrics and Visualization Analysis
We used VOSviewer 1.6.19 and CiteSpace6.2.4 for the bibliometric analysis and data visualization. Manual reviews were conducted to standardize the names of institutions and authors to ensure consistency in the bibliometric analysis. The plain text was imported into VOSviewer to construct and visualize bibliometric networks based on citation, bibliographic coupling, co-citation, or co-authorship relations. Altogether, VOSviewer also provided the collaborative relationships among institutions, knowledge structure, research hotspots and trends. Citespace is another important scientometric tool that is commonly used to create mapping and visualization of bibliographic data.14 These analytic tools offered objective and diverse perspectives on the development of the research on dexmedetomidine in perioperative medicine.
Results
Annual Publications and Trends
There were 1,652 correlative records from the Web of Science core database during 1991–2022, including articles (n=1,497) and reviews (n=155) for bibliometric analysis. The annual number of publications and their cumulative numbers on dexmedetomidine in perioperative medicine is shown in Figure 2. Those publications increased sluggishly between 1991 and 2012. Noteworthy, the last decade has witnessed a consistent and accelerated increase. Specifically, the number of publications in this field has grown over 100 per year and the upward trends has become more noticeable since 2016.
Distribution of Countries/Regions
During the period from 1991 to 2022, 57 countries and regions published research publications related to this topic. Table 1 demonstrates the top 15 countries/regions with the highest number of publications. China produced the largest proportion of publications, followed by United States (US) and South Korea. However, US had the highest mean citations per publication. Inconsistent with the number of publications, England had the highest mean number of citations per paper, followed by Finland and the US of these top 15 countries/regions. As shown in Figure 3A, the number of publications from China has increased significantly over the last 10 years. To improve visual clarity, VOSviewer was used to analyze the cooperation between countries/regions for each published paper (Figure 3B). The size of the circle represents the total link strength and the thickness of the connecting lines indicates the level of collaboration between the countries/regions. The US has the greatest total link strength and cooperates with a wide range of countries/regions. We also found that the most frequent cooperation was between China and US.
Enlarge this image.Figure 3 (A) Growth Trends of the Top 5 Countries from 2013 to 2022; (B) The Network Visualization Map of Collaborations between Countries/Regions.
Distribution of Institutions
Approximately 1,421 institutions were participated in research on dexmedetomidine in perioperative medicine. The top 15 prolific institutions were analyzed in Table 2. It was notable that 12 institutions were from China, the other three came from South Korea, Egypt and Canada. The top 6 Chinese institutions all produced more than 30 publications, while the mean citations per paper were less than 25. Interestingly, although the University of Toronto offered the least publications of the top 15 institutions, it had the highest average number of citations per paper. In contrast, many of the Chinese institutions had low citation counts per paper, despite their comparatively high number of total publications.
Distribution of Journals
All publications were published in 436 journals, most of which originated in anesthesiology-related fields. Table 3 lists the top 15 prolific journals. BMC Anesthesiology was the most popular journal with 65 publications, followed by Medicine (n = 62) and International Journal of Clinical and Experimental Medicine (n = 62), while their total citations were modest. Regarding citations, the top three journals were Anesthesia and Analgesia, Anesthesiology and British Journal of Anaesthesia which were the authoritative journals in anesthesiology. Expectedly, Anesthesiology was ranked first in mean citations per paper. Regrettably, none of the top 15 journals had an impact factor over 12, with the highest impact factor being the British Journal of Anesthesia (IF=11.7).
Analysis of Authors
A total of 7,733 authors made contributions to all of the publications on dexmedetomidine in perioperative medicine. The top 15 authors with the highest number of publications were analyzed and exhibited in Table 4. Ji Fuhai was the most prolific author in this field, followed by liu Hong and Peng Ke. Ji Fuhai and Peng Ke came from the same institution and had fruitful cooperation with Liu Hong from the US. Inconsistent with the number of papers, the top three researchers of mean citations were Ma Daqing, Kallio Antero and Scheinin Harry. The H-index is a metric that evaluates a researcher’s academic influence by analyzing both their number of publications and citation frequency, providing a comprehensive score of their scholarly impact. The highest H-index owner was Ma Daqing, followed by Scheinin Harry and Tobias Joseph D. The collaborative relationships of researchers with more than 4 publications were shown in Figure 4. Although many authors had published relevant papers, their distributions were decentralized indicated that the partnerships were regional and more large-scale, high-quality collaborations were needed in the future.
Analysis of Keywords and Burst Keywords
The analysis of keywords is particularly important in bibliometrics, not only as the core of the paper but also their more condensed information and representativeness when presenting domain analyses. Research hotspots can be determined by keyword co-occurrence analysis, which is defined as the frequency of two keywords occurring simultaneously in the same paper. There were 3,395 keywords extracted from all publications. Expectedly, dexmedetomidine was the most frequent keyword. These keywords except dexmedetomidine occurred more than 20 times were mapped by VOSviewer software. As shown in Figure 5A, the size of the circles represents the frequency of occurrence of keywords.
Enlarge this image.Figure 5 (A) The Network Visualization Map of Keywords Co-occurrence Analysis; (B) Overlay Visualization Map of Co-occurrence Dynamics Keywords; (C) The Top 15 Keywords with the Strongest Citation Bursts.
“Sedation”, “anesthesia”, “surgery”, “propofol” and “analgesia” were the top 5 high-frequency keywords with the bigger size of the circles. Those keywords were divided into 5 clusters with different colors. The red cluster mainly related functional impairment of tissue or organ with the keywords such as “delirium”, “ischemia”, “stress” and “inflammation”. The green cluster focused mainly on sedation and general anesthesia, including “sedation”, “anesthesia” and “propofol”. The blue cluster involved the studies on regional anesthesia containing “analgesia”, “bupivacaine” and “nerve block”. The green cluster was mainly in association with pediatric anesthesia and anxiolytic, including the keywords such as “children”, “anxiety” and “midazolam”. The violet cluster contained the studies on clinical trials, comprising “meta-analysis”, “double-blind” and “efficacy”. Figure 5B demonstrated the evolution of high-frequency keywords. Evidence-based medicine, protection of vital organs of dexmedetomidine in the perioperative medicine are key areas of current research.
“Burst keywords” refers to the phenomenon of keywords being referenced frequently within a specific time, thereby indicating the research hotspots and frontier areas. Figure 5C showed the top 15 keywords with the strongest citation bursts of the last decade. “Clonidine” became research hotpot from 2013 to 2016 with the highest strength, followed by “elderly patients” and “pediatric patients”. There is no doubt that the use of dexmedetomidine in pediatric and geriatric patients has been a hot spot of clinical research. Furthermore, “postoperative delirium”, “elderly patients”, “postoperative cognitive dysfunction”, “injury”, “risk factors” and “dysfunction” had become burst and lasted until now.
Analysis of Co-Citation References and Co-Citation Journals
Citation rates reflect the importance and recognition of publications in the scientific community. The top 10 most frequently co-cited journals were listed in Table 5. Eight of the top 10 co-citation journals were from the field of anesthesiology. The other two were comprehensive journals and journals related to critical care medicine, respectively. Anesthesiology had the highest number of co-citations among all journals, reflecting its authoritative position in the field of anesthesiology.
We also listed the top 10 co-citation references based on annual average citations during the last decade in Table 6. Five of these were RCTs, three reviews, and two meta-analysis. The RCTs published in top journals have led the way in advancing dexmedetomidine research. Both two meta-analyses published in British Journal of Anesthesia. The most cited paper was a review published in Clinical Pharmacokinetics. Additionally, not all papers were published in journals with high impact factors.
Discussion
We conducted a bibliometric analysis of 1,652 publications on dexmedetomidine in perioperative medicine collected from Web of Science Core Collection by 2022 to summarize the general situation, research hotspots and trends. Although dexmedetomidine may cause bradycardia and delayed awakening, it is widely used during the perioperative period because of its unique sedative effects and minimal respiratory depression.17,18
By analyzing the growth in publications, we can obtain information on research outputs and trends in this field. The development of dexmedetomidine research in the perioperative period can be divided into two phases: “fluctuating growth” and “spurting growth”. Since 2013, there has been an overall rapid upward trend in the number of annual publications in this area, indicating a gradual increase of research interest in the perioperative use of dexmedetomidine. Chinese researchers have made an irreplaceable contribution to this growing trend. Ji’s retrospective research about perioperative use of dexmedetomidine reduced the incidence of complications and mortality after cardiac surgery published in Circulation. It was one of the most far-reaching studies in anesthesiology that year, and became an important catalyst for subsequent research.19
The number of publications can sometimes partly reflect the country’s academic dominance in the field. Although China has since emerged as the most prolific country in the last decade, it needs to expand the width and depth of research to increase international influence. The US remains an undeniable position in this field because it has the widest collaborative network. Despite the modest number of publications, we cannot ignore the importance of the United Kingdom (UK) in this field. Our study found that several publications involving British researchers were widely cited, which led to the UK being the most highly cited country for mean number of citations per paper.13,20–22 Additionally, the results of the study showed China had become a major contributor to highly productive research institutions. Inter-institutional collaborations were mainly concentrated within the same country or region, and there were relatively little cross-country collaborations. Therefore, we suggest enhancing national and inter-institutional collaborations to promote the progress of scientific research.
We next analyzed the contributions of authors. The top 3 prolific authors had close cooperation for over 10 years. Their studies on dexmedetomidine were multifaceted. The types of studies included RCTs, mate-analyses and basic research.12,23–25 However, their RCTs were mostly single-center studies with limited generalizability of findings. Wang Dongxin was another prolific author from China, mainly contributing to research on the effects of dexmedetomidine on delirium, analgesia and sleep quality.26–28 The highly cited publication on dexmedetomidine for preventing delirium in elderly patients after non-cardiac surgery, published in Lancet, was a collaboration with Daqing Ma from Imperial College London.13 Among the top 15 most prolific authors in this field, Ma had the highest h-index, demonstrating his significant academic influence in this research area. Tobias, Joseph D from the USA mainly focused on dexmedetomidine in pediatric patients.29,30 Scheinin, Harry and Kallio, Antero were pioneers in this field. They carried out the early research to evaluate the effects of dexmedetomidine and promoted its approval for analgesia and sedation of critically ill patients on mechanical ventilation in the intensive care unit.31,32 While there was some collaboration among these prolific authors, it was limited and localized.
BMC Anesthesiology, Medicine and International Journal of Clinical and Experimental Medicine were the top-3 journals for publications on dexmedetomidine in the perioperative period. Furthermore, they had a certain academic influence in anesthesiology. International Journal of Clinical and Experimental Medicine was no longer included in SCIE. Those journals including Anesthesia and Analgesia, Journal of Clinical Anesthesia, British Journal of Anesthesia and Anesthesiology that authors should focus on if they are concerned about high-quality studies on dexmedetomidine.
Keywords are a summary of the article’s research and subject information. After removing duplicates, we filtered out the five most frequently occurring keywords: “sedation”, “analgesia”, “cardiac surgery”, “children” and “delirium”. It was obvious that these five keywords represent five research hotspots for the perioperative use of dexmedetomidine. Dexmedetomidine, which produces both sedation and a degree of wakefulness, is becoming more widely used in patients undergoing mechanical ventilation.33 Although dexmedetomidine reduced the duration of mechanical ventilation and delirium in critical patients, the results were no different from those of patients who received propofol.34 Additionally, a recent retrospective cohort study has also shown that perioperative infusion of dexmedetomidine is associated with an improved 5-year survival rate in patients undergoing cardiac surgery.12 Despite progress in these hotspots, more efforts are needed for further research. The emergence of the high-frequency keywords “double-blind” and “mate-analysis” is an indication that researchers are gradually paying more attention to quality control.
The research trends could be identified from the burst keywords and overlay visualization. “Postoperative cognitive dysfunction”, “postoperative delirium”, “elderly patients”, “inflammation” and “neuroinflammation” have appeared more frequently in recent years. Furthermore, the six persistent burst keywords were “postoperative delirium”, “elderly patients”, “postoperative cognitive dysfunction”, “injury”, “risk factors” and “dysfunction”. We therefore concluded that the study of dexmedetomidine for postoperative cognitive dysfunction is a current topic that may receive more attention in the next few years. Stacie Deiner and Alparslan Turan’s RCTs showed that intraoperative dexmedetomidine did not prevent and reduce postoperative delirium.35,36 However, dexmedetomidine showed a lower incidence of postoperative delirium than propofol in healthy older adults undergoing lower extremity orthopedic surgery.37 The conflicting findings suggest that dexmedetomidine’s effectiveness may depend on multiple factors: timing of administration, patient characteristics, and surgical procedures. Future well-controlled multicenter studies should focus on standardizing protocols and investigating optimal patient selection criteria to develop evidence-based guidelines for clinical use. Meanwhile, most researchers have focused on neuroinflammation to explore its mechanisms.38,39 It is important to design more rigorous and scientific studies to provide high-quality evidence about the use of dexmedetomidine in perioperative medicine and to increase research into the exact mechanisms in the future.
While our bibliometric analysis identified significant research interest in both pediatric and geriatric populations through keyword analysis, a detailed examination of age-specific outcomes was beyond the scope of this study. Our analysis included publications covering all age groups where dexmedetomidine was used perioperatively, from pediatric to geriatric populations. Future systematic reviews specifically focusing on age-stratified outcomes of perioperative dexmedetomidine use would be valuable to better understand its efficacy and safety across different age groups.
Our study has some limitations. First, the data was obtained from Web of Science core database, which is the most widely used and recommended database for bibliometric analysis. It is likely that many studies from Chinese or other English-language databases have not yet been indexed, and future studies might benefit from incorporating additional databases. Second, as a quantitative study, bibliometric analysis is not an assessment of the quality of the published papers. Finally, due to the low citation frequency, newly published and potentially influential papers may not have been included in our study. Therefore, research and trends in dexmedetomidine may be subject to change as bibliometric data are updated.
Conclusion
Our study elucidated the current research hotspots and emerging trends of dexmedetomidine in perioperative medicine by a bibliometric analysis. Research on dexmedetomidine is flourishing all over the world and continues to expand at a rapid pace. China is undoubtedly the largest contributor and remains a dominant role in global research. The effect of perioperative application of dexmedetomidine on cognitive function has been the latest research hotspot. In the future, we need to design more rigorous and scientific multi-center studies to provide high-quality evidence, and further strengthen collaborations and academic exchanges to advance research in this field.
Data Sharing Statement
The datasets used and analysed during the current study are available from the corresponding author on reasonable request.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare that they have no competing interests.
1. Bollen Pinto B, Chew M, Lurati Buse G et al. The concept of peri-operative medicine to prevent major adverse events and improve outcome in surgical patients: a narrative review. Eur J Anaesthesiol. 2019;36(12):889–903. doi:10.1097/EJA.0000000000001067
2. Beutler S, McEvoy MD, Ferrari L et al. The Future of Anesthesia Education: developing Frameworks for Perioperative Medicine and Population Health. Anesth Analg. 2020;130(4):1103–1108. doi:10.1213/ANE.0000000000004686
3. Weerink MAS, Struys M, Hannivoort LN et al. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913. doi:10.1007/s40262-017-0507-7
4. Farag E. Dexmedetomidine: a multifaceted drug in perioperative medicine. J Clin Anesth. 2019;55:1–2. doi:10.1016/j.jclinane.2018.12.015
5. Wang K, Wu M, Xu J, et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019;123(6):777–794. doi:10.1016/j.bja.2019.07.027
6. Miao M, Xu Y, Li B et al. Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: a meta-analysis of randomized controlled trials. J Clin Anesth. 2020;65:109849. doi:10.1016/j.jclinane.2020.109849
7. Chen Z, Liu Z, Feng C et al. Dexmedetomidine as an Adjuvant in Peripheral Nerve Block. Drug Des Devel Ther. 2023;17:1463–1484. doi:10.2147/DDDT.S405294
8. Xuan C, Yan W, Wang D, et al. The Facilitatory Effects of Adjuvant Pharmaceutics to Prolong the Duration of Local Anesthetic for Peripheral Nerve Block: a Systematic Review and Network Meta-analysis. Anesth Analg. 2021;133(3):620–629. doi:10.1213/ANE.0000000000005640
9. Diwan G, Bharti AK, Rastogi K et al. Comparison of Intranasal Dexmedetomidine and Midazolam as Premedication in Pediatric Surgical Patients: a Prospective, Randomized Double-Blind Study. Anesth Essays Res. 2020;14(3):384–389. doi:10.4103/aer.AER_102_20
10. Lin Y, Chen Y, Huang J, et al. Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane. J Clin Anesth. 2016;33:289–295. doi:10.1016/j.jclinane.2016.04.027
11. Plambech MZ, Afshari A. Dexmedetomidine in the pediatric population: a review. Minerva Anestesiol. 2015;81(3):320–332.
12. Peng K, Shen YP, Ying YY, et al. Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery. Br J Anaesth. 2021;127(2):215–223. doi:10.1016/j.bja.2021.03.040
13. Su X, Meng Z-T, Wu X-H, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10054):1893–1902. doi:10.1016/s0140-6736(16)30580-3
14. Chen C, Song M. Visualizing a field of research: a methodology of systematic scientometric reviews. PLoS One. 2019;14(10):e0223994. doi:10.1371/journal.pone.0223994
15. Ellegaard O, Wallin JA. The bibliometric analysis of scholarly production: how great is the impact? Scientometrics. 2015;105(3):1809–1831. doi:10.1007/s11192-015-1645-z
16. Roldan-Valadez E, Salazar-Ruiz SY, Ibarra-Contreras R et al. Current concepts on bibliometrics: a brief review about impact factor, Eigenfactor score, CiteScore, SCImago Journal Rank, Source-Normalised Impact per Paper, H-index, and alternative metrics. Ir J Med Sci. 2019;188(3):939–951. doi:10.1007/s11845-018-1936-5
17. Zhang J, Sun X, Cheng W et al. Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions. J Healthc Eng. 2021;2021:3080098. doi:10.1155/2021/3080098
18. Shehabi Y, Howe BD, Bellomo R, et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. N Engl J Med. 2019;380(26):2506–2517. doi:10.1056/NEJMoa1904710
19. Ji F, Li Z, Nguyen H, et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation. 2013;127(15):1576–1584. doi:10.1161/CIRCULATIONAHA.112.000936
20. Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012;307(11):1151–1160. doi:10.1001/jama.2012.304
21. Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Br J Anaesth. 2001;87(5):684–690. doi:10.1093/bja/87.5.684
22. Venn RM, Bryant A, Hall GM et al. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit. Br J Anaesth. 2001;86(5):650–656. doi:10.1093/bja/86.5.650
23. Ji F, Liu H. Intraoperative hypernatremia and polyuric syndrome induced by dexmedetomidine. J Anesth. 2013;27(4):599–603. doi:10.1007/s00540-013-1562-3
24. Zhu YJ, Peng K, Meng XW et al. Attenuation of neuroinflammation by dexmedetomidine is associated with activation of a cholinergic anti-inflammatory pathway in a rat tibial fracture model. Brain Res. 2016;1644:1–8. doi:10.1016/j.brainres.2016.04.074
25. Peng K, Ji FH, Liu HY et al. Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity: a Systematic Review and Meta-analysis. Clin Ther. 2019;41(1):138–154e134. doi:10.1016/j.clinthera.2018.10.022
26. Hong H, Zhang DZ, Li M, et al. Impact of dexmedetomidine supplemented analgesia on delirium in patients recovering from orthopedic surgery: a randomized controlled trial. BMC Anesthesiol. 2021;21(1):223. doi:10.1186/s12871-021-01441-3
27. Wu XH, Cui F, Zhang C, et al. Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit: a Pilot Randomized Controlled Trial. Anesthesiology. 2016;125(5):979–991. doi:10.1097/ALN.0000000000001325
28. Wang BJ, Li CJ, Hu J, et al. Impact of dexmedetomidine infusion during general anaesthesia on incidence of postoperative delirium in elderly patients after major non-cardiac surgery: study protocol of a randomised, double-blinded and placebo-controlled trial. BMJ Open. 2018;8(4):e019549. doi:10.1136/bmjopen-2017-019549
29. Gupta P, Whiteside W, Sabati A, et al. Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease*. Pediatr Crit Care Med. 2012;13(6):660–666. doi:10.1097/PCC.0b013e318253c7f1
30. Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8(2):115–131. doi:10.1097/01.PCC.0000257100.31779.41
31. Aho M, Erkola O, Kallio A et al. Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole. J Clin Anesth. 1993;5(3):194–203. doi:10.1016/0952-8180(93)90014-6
32. Virkkila M, Ali-Melkkila T, Kanto J et al. Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo. Anaesthesia. 1994;49(10):853–858. doi:10.1111/j.1365-2044.1994.tb04257.x
33. Heybati K, Zhou F, Ali S, et al. Outcomes of dexmedetomidine versus propofol sedation in critically ill adults requiring mechanical ventilation: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth. 2022;129(4):515–526. doi:10.1016/j.bja.2022.06.020
34. Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: the DEXACET Randomized Clinical Trial. JAMA. 2019;321(7):686–696. doi:10.1001/jama.2019.0234
35. Deiner S, Luo X, Lin HM, et al. Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: a Randomized Clinical Trial. JAMA Surg. 2017;152(8):e171505. doi:10.1001/jamasurg.2017.1505
36. Turan A, Duncan A, Leung S, et al. Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trial. Lancet. 2020;396(10245):177–185. doi:10.1016/S0140-6736(20)30631-0
37. Shin HJ, Woo Nam S, Kim H, et al. Postoperative Delirium after Dexmedetomidine versus Propofol Sedation in Healthy Older Adults Undergoing Orthopedic Lower Limb Surgery with Spinal Anesthesia: a Randomized Controlled Trial. Anesthesiology. 2023;138(2):164–171. doi:10.1097/ALN.0000000000004438
38. Liaquat Z, Xu X, Zilundu PLM et al. The Current Role of Dexmedetomidine as Neuroprotective Agent: an Updated Review. Brain Sci. 2021;11(7):846. doi:10.3390/brainsci11070846
39. Alam A, Hana Z, Jin Z. Surgery, neuroinflammation and cognitive impairment. EBioMedicine. 2018;37:547–556. doi:10.1016/j.ebiom.2018.10.021
Teng Zheng,1 Zhi Pei,1 Xiaojing Huang1,2
1Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Pain Medicine, Shanghai Geriatric Medical Center, Minhang District, Shanghai, People’s Republic of China
Correspondence: Xiaojing Huang, Department of Pain Medicine, Shanghai Geriatric Medical Center, Minhang District, Shanghai, 201104, People’s Republic of China, Email [email protected]
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