Effect of Perioperative Low-Dose Dexmedetomidine on Postoperative Delirium After Living-Donor Liver Transplantation: A Randomized Controlled Trial

Postoperative delirium after liver transplantation (LT) is associated with increased hospital length of stay and higher morbidity and mortality. Dexmedetomidine is a recommended and widely used sedative in critically ill patients with reports of potential for delirium prevention. A randomized controlled clinical trial was performed to investigate whether perioperative low-dose dexmedetomidine infusion would decrease delirium after living-donor LT. Dexmedetomidine (0.1 mcg/kg/hour) was administered during anesthesia and through postoperative day 2 for patients in the dexmedetomidine group, whereas 0.9% saline was administered at the same rate for the same duration for patients in the control group. The incidence of delirium after LT was compared between the 2 groups. Delirium duration, mechanical ventilation duration, intensive care unit (ICU) and hospital length of stay, and in-hospital and 3-month mortality were also compared. There was no significant difference in delirium incidence in the dexmedetomidine group compared to the control group (9% vs 5.9%; P = .44). Duration of delirium and mechanical ventilation, ICU and hospital length of stay, and in-hospital and 3-month mortality were comparable between the 2 groups. Perioperative low-dose dexmedetomidine infusion did not reduce the incidence of delirium in living-donor LT. •The reported frequency of delirium after liver transplantation (LT) ranges from 12.2% to 47%.•Dexmedetomidine is a recommended sedative for patients in the intensive care unit (ICU), as, it has been associated with less delirium and a shorter duration of delirium compared to benzodiazepines.•Delirium after LT occurred in 9 patients (9%) in the dexmedetomidine group and 6 patients (5.9%) in the control group (P = .44).•Preoperative international normalized ratio for prothrombin time (odds ratio [OR] = 16.23; 95% confidence interval [CI], 4.46-59.03; P < .01), APACHE II score (OR = 1.10; 95% CI, 1.02-1.19; P = .02), and vasopressor support during ICU stay (OR = 13.47; 95% CI, 2.89-62.77; P < .01) were significant predictors of delirium after LT.