Drug Des Devel Ther. 2026 Oct 2;20:598574. doi: 10.2147/DDDT.S598574. eCollection 2026.
ABSTRACT
BACKGROUND: Postoperative delirium is common after major head and neck cancer surgery. We investigated whether intraoperative dexmedetomidine infusion was associated with a lower incidence of postoperative delirium in patients undergoing head and neck cancer surgery requiring free-flap reconstruction.
METHODS: This was a delirium-focused secondary analysis of a single-centre, randomized, double-blind, placebo-controlled trial. Adult patients with head and neck cancer scheduled for elective surgery requiring free-flap reconstruction under general anaesthesia were randomly assigned to receive intraoperative dexmedetomidine infusion at 0.3 μg kg-1h-1 until 1 h before the end of surgery; subjects in the placebo group were given comparable volumes of normal saline. The primary outcome was the incidence of delirium during the first 5 postoperative days, assessed once daily using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or the 3-Minute Diagnostic Confusion Assessment Method (3D-CAM).
RESULTS: There was less delirium during the initial 5 postoperative days in patients assigned to dexmedetomidine (14.9%, 7 of 47 patients) than in those given placebo (34.7%, 17 of 49 patients). Dexmedetomidine was associated with lower odds of postoperative delirium after adjustment for age, preoperative Mini-Mental State Examination score, and operative time (adjusted odds ratio 0.31, 95% confidence interval 0.10-0.92; p = 0.036). Postoperative pain and early sleep outcomes were improved by dexmedetomidine. Haemodynamic adverse events and postoperative complications did not differ significantly between groups.
CONCLUSION: In patients undergoing head and neck cancer surgery with free-flap reconstruction, intraoperative dexmedetomidine infusion was associated with a lower incidence of postoperative delirium during the first 5 postoperative days, without an apparent increase in perioperative adverse events.
CLINICAL TRIAL REGISTRATION: ChiCTR2300067376.
PMID:42840768 | PMC:PMC13641108 | DOI:10.2147/DDDT.S598574
