Effects of Sedation Medications on Postoperative Delirium and Cognitive Dysfunction in Cardiac Surgery Patients with Cardiopulmonary Bypass: A Network Meta-Analysis

Background: Neuropsychological deficits, such as delirium and cognitive dysfunction, are common consequences of cardiac surgery. The effectiveness of sedative drugs remains controversial. The purpose of this study was to collect and summarize the current evidence on the application of sedatives in randomized trials to prevent delirium and cognitive dysfunction in adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: We searched for relevant studies in the databases from inception to September 1, 2024. Randomized controlled trials (RCTs) investigating the effects of sedatives and comparators on postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in adults undergoing cardiac surgery with CPB were included in this research. Frequentist network meta-analysis (NMA) was utilized for comparing various interventions. Results: Forty-five RCTs were included in the analysis. For POD, there were statistically significant differences between the dexmedetomidine group and the control group (odds ratio [OR]: 0.70; 95% CI: 0.50, 0.98; p = 0.038), which was mainly dependent on the effect of the postoperative application. Ketamine (92%) and esketamine (91%) also showed higher surface under the cumulative ranking curve (SUCRA) ranks, and trial sequential analysis also indicated their potential effectiveness. For the Mini-Mental State Examination (MMSE) outcome, the results indicated that dexmedetomidine (standardized mean difference [SMD]: 3.14; 95% CI: 1.12, 5.16; p = 0.002) and remifentanil (SMD: 4.24; 95% CI: 0.28, 8.20; p = 0.036) resulted in significantly higher MMSE scores than the control group. Conclusions: Postoperative dexmedetomidine significantly outperformed the control in terms of POD risk and MMSE score. Esketamine/ketamine also demonstrated potential efficacy in preventing POD. Further research is required to validate these findings.