Intraoperative Dexmedetomidine and Postoperative Delirium After Head and Neck Cancer Surgery with Free-Flap Reconstruction: A Secondary Analysis of a Randomized Placebo-Controlled Trial.

In 30 seconds

This delirium-focused secondary analysis of a single-centre, randomized, double-blind, placebo-controlled trial examined adults undergoing elective head and neck cancer surgery with free-flap reconstruction. Patients received intraoperative dexmedetomidine or saline, and delirium was assessed daily during the first 5 postoperative days. Delirium occurred in 14.9% (7 of 47 patients) assigned dexmedetomidine and 34.7% (17 of 49 patients) assigned placebo. After adjustment for age, preoperative cognitive score, and operative time, dexmedetomidine was associated with lower odds of delirium (adjusted odds ratio 0.31, 95% confidence interval 0.10-0.92; p = 0.036).

Key findings

• Delirium during the first 5 postoperative days occurred in 14.9% (7 of 47 patients) with dexmedetomidine versus 34.7% (17 of 49 patients) with placebo.
• Adjusted odds of postoperative delirium were lower with dexmedetomidine (adjusted odds ratio 0.31, 95% confidence interval 0.10-0.92; p = 0.036).
• Postoperative pain and early sleep outcomes improved with dexmedetomidine; haemodynamic adverse events and postoperative complications did not differ significantly between groups.

Why it matters

Delirium is a relevant postoperative outcome after major head and neck cancer surgery. These randomized-trial data suggest that intraoperative dexmedetomidine may reduce delirium in patients undergoing free-flap reconstruction, alongside improvements in pain and early sleep outcomes. The findings add evidence for considering delirium prevention in perioperative care, while the secondary-analysis design warrants cautious interpretation.

What to keep in mind

This was a delirium-focused secondary analysis of a single-centre trial, so the findings may not generalize to other settings or surgical populations.