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Intravenous dexmedetomidine for delirium prevention in elderly patients following orthopedic surgery: a meta-analysis of randomized controlled trials

BMC Pharmacology and Toxicology volume 26, Article number: 8 (2025) Cite this article

Abstract

Objectives

We conducted a meta-analysis to investigate the effect of dexmedetomidine on postoperative delirium in elderly orthopedic surgery patients.

Methods

A meta-analysis was conducted to identify randomized controlled trials of dexmedetomidine in elderly patients undergoing orthopedic surgery. The data was published on October 25, 2024. PubMed, Embase, and Cochrane Library databases were searched. Outcome measures included incidence of delirium, length of hospital stay, visual analogue scale, and postoperative complications. Estimates are expressed as relative risk (RR) or mean difference (MD) with a 95% confidence interval (CI). The publications were reviewed according to the guidelines of the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

This study was registered with INPLASY (number INPLASY2024110004). A total of 3159 patients were included in 9 randomized controlled trials. The results showed that dexmedetomidine exhibited a preventive effect on delirium compared with the control group in elderly patients after orthopedic surgery (RR: 0.55, 95% CI: 0.45–0.66, P < 0.01, I2 = 0%). Subgroup analysis suggested that dexmedetomidine was significantly different from saline(RR: 0.56; 95% CI: 0.44–0.73, P<0.01, I²=31%) and propofol(RR: 0.52; 95% CI: 0.39–0.70, P<0.01, I²=0%) in reducing postoperative delirium in elderly fracture patients. No statistically significant differences were observed in length of hospital stay, visual analogue scale, and postoperative complications (P > 0.05). Certainty of evidence for postoperative delirium was moderate.

Conclusions

Dexmedetomidine has been shown to have a protective effect on postoperative delirium in elderly patients following orthopedic surgery.

Peer Review reports

Introduction

Postoperative delirium (POD) is a neurological disorder associated with temporary loss of consciousness and cognitive dysfunction. The exact etiology of POD remains uncertain [1]. The occurrence of POD is related to a number of factors, including the patient’s age, the type of surgery, the anesthesia and sedation administered during the procedure, and the complications that arise during the surgery. Elderly patients who have undergone fracture surgery have been shown to have a number of characteristic features, including advanced age, prolonged bed rest, blood loss, and the presence of underlying comorbidities. The incidence of POD is 32–53.3% [1], which is significantly higher than in younger patients [2]. POD has been shown to increase the risk of short- and long-term complications in older patients who have sustained a fracture and undergone surgery. Additionally, it has been shown to prolong hospital stay and increase associated costs [3–4]. Therefore, it is of great clinical importance to identify effective preventive measures against delirium in this population.

Dexmedetomidine is a highly selective α-2-adrenergic receptor antagonist that can inhibit sympathetic nerve excitability [5], increase vagus nerve excitability, lower blood pressure, lower heart rate, and reduce myocardial oxygen consumption. In addition, dexmedetomidine has been observed to cause sedation, analgesia, anxiolytic effects, hypnosis, memory loss, and anesthesia-like symptoms. The drug exerts a sedative effect by inhibiting the division of neurons, thereby reducing the perception of pain and anxiety. The pharmacological properties of dexmedetomidine include rapid absorption, rapid distribution, rapid metabolism and rapid excretion. In clinical practice, dexmedetomidine is used for sedation, analgesia and sedation, as well as for intraoperative and postoperative sedation and analgesia [6]. Additionally, dexmedetomidine has been shown to inhibit central nervous system activity, thereby reducing pain in patients [7]. A number of studies have documented the neuroprotective effects of dexmedetomidine [8]. Nevertheless, the results of recent randomized controlled trials suggest that the effectiveness of dexmedetomidine in reducing the incidence and safety of POD in elderly patients undergoing orthopedic surgery is still inconclusive. The aim of this study is to conduct a meta-analysis to evaluate the potential protective effect of dexmedetomidine on the occurrence of POD in elderly patients undergoing orthopedic procedures.

Methods

The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [9]. The protocol has been registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols database (Inplasy protocol: INPLASY2024110004) and is fully available on Inplasy.com (https://inplasy.com/inplasy-2024-11-0004/). Ethical approval was not required for this study.

Search strategy

Three researchers (Jing Sun, Duo Wang, and Yue Zhao) conducted a comprehensive electronic literature search for articles published in this area before October 25, 2024. The database includes PubMed, Embase and the Cochrane database. The PubMed basic search strategy as follows: (cataclasis[Title/Abstract] OR fracture[Title/Abstract] OR joint[Title/Abstract] OR articulation[Title/Abstract] OR arthroplasty[Title/Abstract] OR limb[Title/Abstract] OR orthopedic[Title/Abstract]) AND (dexmedetomidine[Title/Abstract]) AND (delirium[Title/Abstract] OR deliriums[Title/Abstract]). Manually select relevant randomized controlled trials. The search strategy of the literature was shown in the supplement (Supplementary file: Table S1). Language is limited to English.

Study selection criteria

This systematic review and meta-analysis focused primarily on elderly patients (60 years or older) undergoing orthopedic surgery. All published full-text randomized controlled trials (RCTs) comparing the effectiveness of dexmedetomidine with other agents (such as placebo or propofol) in preventing postoperative delirium after orthopedic surgery were eligible for inclusion. The outcomes were the incidence of delirium after orthopedic surgery, the length of hospital stay, visual analog scale, and complications 30 days after surgery (defined as new-onset adverse conditions requiring therapeutic intervention according to the Clavien-Dindo classification, which included grade 2 or higher)., including acute renal failure, pulmonary infection, disease control and disease control). Heart failure, myocardial infarction, new cardiac arrhythmias, pulmonary embolism or deep vein thrombosis, and cerebrovascular disease or wound infections. We excluded animal studies, studies involving patients under 18 years of age, and insufficient data to be extracted such as abstracts, reviews, pharmacological presentations, and other literature. Literature that does not agree with the content of this study will also be excluded. If we need relevant research data, we contact the authors. Chizophrenia, epilepsy, parkinsonism, or coma were excluded from the study population. Non-intravenous administration, inappropriate control group settings, and inaccurate data extraction were also excluded.

Data extraction

Three authors undertook the data extraction independently, using the established standard data collection table. The extracted data are as follows: the first author’s name, the year of publication, the basic characteristics of the participants, the type of surgery, the method of assessment of POD, the strategy of dexmedetomidine infusion, outcomes mentioned above, method of anesthesia and exclusion criteria.

Bias & quality assessment

Two researchers independently selected and reviewed the literature data using a uniform and standardized method and included them in the literature in strict compliance with the eligibility and exclusion criteria. They then collected information. The quality of the selected articles was assessed according to the standards of the Cochrane Reviewer Handbook, version 5.1.0 [10], using the RoB 2.0 tool. We used the funnel plot to assess the publication bias of the studies, and to ensure the accuracy of the results, we considered excluding studies with significant publication bias.

Data synthesis and analysis

The meta-analysis was conducted using RevMan 5.4. Data that met the criteria for homogeneity (P > 0.10 and I²≤50%) as determined by the heterogeneity test were subjected to meta-analysis using the fixed-effect model (M-H). In cases where the above homogeneity criteria were not met (P ≤ 0.10 or I2 > 50%) and the presence of heterogeneity could not be excluded, the random effects model was used to consolidate the effects [11]. A prespecified subgroup analysis was performed according to the control group (saline or propofol) administration strategy. Estimates are expressed as relative risk (RR) or mean difference (MD) with a 95% confidence interval (CI). A p value less than 0.05 was considered statistically significant.

Certainty assessment

This study assessed research certainty according to the criteria of theGRADE (Grading of Recommendations Assessment, Development, and Evaluation) Guidelines Working Group [12]. According to the corresponding evaluation criteria, the evidence level was classified (divided into 4 categories: high, moderate, low and very low) [13].

Results

The flowchart provides a summary of the process for identifying and selecting studies for review (Fig. 1). A total of 219 related literatures were retrieved, of which 91 were excluded due to duplicates. In addition, 109 studies were excluded after a preliminary assessment of titles and abstracts. The remaining 19 studies underwent a more comprehensive assessment through a thorough reading of the full texts. Data from nine studies [14,15,16,17,18,19,20,21,22] evaluating the efficacy and safety of dexmedetomidine for the prevention of delirium in elderly patients undergoing orthopedic surgery were included in the final analysis.

Fig. 1
figure 1

The flow chart of the search and study selection process

Full size image

The trials included in this review were published between 2016 and 2024 and included a total of 3159 patients (1580 in the dexmedetomidine group and 1579 in the control group). The detailed characteristics of the included trials were presented in Table 1.

Table 1 Design and outcomes of the studies included in the meta-analysis
Full size table

A total of nine studies with a total of 3159 patients showed that dexmedetomidine significantly reduced the incidence of POD in elderly patients after orthopedic surgery compared to the control group (Fig. 2, RR: 0.55; 95% CI: 0.45–0.66, P < 0.01, I²=0%). Subgroup analysis suggested that dexmedetomidine was significantly different from saline(RR: 0.56; 95% CI: 0.44–0.73, P<0.01, I = 31%) and propofol(RR: 0.52; 95% CI: 0.39–0.70, P<0.01, I²=0%) in reducing postoperative delirium in elderly fracture patients. Regarding the length of hospital stay (after surgery), we removed studies with significant publication bias that showed no statistically significant difference between dexmedetomidine and control groups (Fig. 3, MD: 0.00; 95% CI: -0.08–0.08, P = 1.00, I²=0%). Furthermore, it had no effect on the visual analogue scale (VAS) (Fig. 4, RR: -1.10; 95% CI: -2.87–0.66, P = 0.22, I²=99%). Three studies reported postoperative complications within 30 days after surgery, which was not a statistically significant difference (Fig. 5, RR: 0.87; 95% CI: 0.61–1.23, P = 0.23, I²=33%).

Fig. 2
figure 2

Forest plot of postoperative delirium (Ns: saline, Pro: propofol)

Full size image
Fig. 3
figure 3

Forest plot of length of stay (Ns: saline, Pro: propofol)

Full size image
Fig. 4
figure 4

Forest plot of visual analogue scale

Full size image
Fig. 5
figure 5

Forest plot of postoperative complications within 30 days of surgery

Full size image

RevMan software is used to see how an individual study affects the overall outcome for each endpoint. The RoB 2.0 tool was used to assess the quality of the research. The quality of included studies was affected by missing outcome data and selection of the reported result, which caused some concerns. GRADE is used to assess the certainty of evidence affected by the risk of bias, inconsistency and imprecision, as described in the supplementary file. Certainty of evidence for postoperative delirium was moderate.

Discussion

Previous research has shown that delirium is a significant health problem [23] that is strongly associated with prolonged hospital stays, mortality, and other complications in patients. Several risk factors have been identified, including a history of cognitive impairment, postoperative pain, use of opioids and sedatives, and postoperative inflammation. These factors have been shown to be associated with delirium [24,25,26]. Consequently, proactive prevention of delirium through non-pharmacological and pharmacological means is a crucial aspect of perioperative management [26].

Dexmedetomidine is a potent α2-adrenergic receptor agonist. Dexmedetomidine inhibits norepinephrine release by activating the α2-adrenergic receptor postsynaptic G proteins, thereby reducing the sympathetic response without significant respiratory depression [6, 7]. Therefore, dexmedetomidine is widely used in orthopedic surgery and postoperative analgesia. The results of this study suggest that perioperative administration of dexmedetomidine may potentially reduce the incidence of POD in elderly patients undergoing orthopedic surgery. The exact etiology of POD remains unclear. The following hypotheses have been proposed: The first hypothesis is the neuroinflammatory process. Surgical trauma promotes the release of cytokines and inflammatory mediators [27], destroys the blood-brain barrier, and increases the inflammatory response of the nervous system, leading to cerebral ischemia and nerve cell apoptosis. Among the studies included in this meta-analysis [14, 18, 20], postoperative serum inflammatory factor levels were measured in included patients, but they could not be combined because the original data could not be extracted. Two studies [14, 20] showed that postoperative serum IL-6 and TNF-a levels were significantly lower in the dexmedetomidine group than in the control group. Secondly, considering the stress response theory [28], patients with bone trauma often suffer from severe pain and long-term abnormal excitation of the sympathetic nerve, resulting in strong stimulation during tracheal intubation and extubation under general anesthesia. This can lead to fluctuations in hemodynamic status and cognitive impairment, with elderly patients being particularly at risk of cognitive impairment due to stress reactions. Third, postoperative sleep arrhythmias [29], postoperative fatigue and metabolic disorders are important risk factors for the occurrence of POD. Studies have shown that sleep deprivation can directly increase astrocyte phagocytosis and promote microglial activation, which has been shown to be a promoting factor for POD development [30]. A study in this meta-analysis showed [14] that intraoperative administration of dexmedetomidine significantly reduced the likelihood of sudden awakening after fast-wave anesthesia compared to controls, a progression comparable to that observed in rapid eye movement sleep, which is often associated with sleep disorders [31]. Finally, opioids are often used for intraoperative analgesia, and the incidence of POD is directly related to the use of opioids, the acute effect of which is to increase the release of serotonin in a wide area of​the forebrain, which can affect various neurotransmitters [32–33]. The pain assessment in this study was limited to the number and heterogeneity of studies and other factors, and the results showed no statistical differences, which requires further research verification in the future. Regarding the length of stay, this study was also limited by factors such as the number of studies and the small number of participants, and no statistical differences in the results were found, which still need to be verified by further research in the future.

The limitations of this study are as follows. First, in this study, different surgical types, anesthesia methods, and dexmedetomidine application strategies may increase the heterogeneity of outcome measurements. Second, this meta-analysis mainly focuses on studies in China and South Korea, and there are certain differences in the exclusion criteria of different studies, which also increases the calculation of outcome indicators to a certain extent. Third, due to the limited sample size of the study, we did not include 30-day all-cause mortality as an end event, which is a significant limitation, and the sensitivity analysis may also affect the accuracy of the results due to the small number of included studies. In conclusion, multicenter, large-scale, randomized, controlled trials on postoperative delirium in orthopedic patients are still the future research direction. Of course, research into the clinical effects of different strategies for dexmedetomidine administration, including in combination with other medications or care measures, on older orthopedic patients is also a future direction. It is also worth examining the influence of different surgical anesthesia methods on postoperative delirium in orthopedic patients.

Conclusion

This meta-analysis suggests that perioperative administration of dexmedetomidine significantly reduces the incidence of POD in elderly orthopedic postoperative patients.

Data availability

Data sets are available on request from the corresponding author.

Abbreviations

ASA:

American Society of Anesthesiologists

CAM:

Confusion assessment method

CI:

Confidence interval

ICU:

Intensive care unit

MD:

Mean difference

MMSE:

Mini-mental State Examination

POD:

Postoperative delirium

RCT:

Randomized controlled trials

RR:

Relative risk

References

  1. Patel V, Champaneria R, Dretzke J, Yeung J. Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review. BMJ Open. 2018;8(12):e020757.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Oh ST, Park JY. Postoperative delirium. Korean J Anesthesiol. 2019;72(1):4–12.

    Article  PubMed  Google Scholar 

  3. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.

    Article  PubMed  Google Scholar 

  4. Hshieh TT, Inouye SK, Oh ES. Delirium in the Elderly. Clin Geriatr Med. 2020;36(2):183–99.

    Article  PubMed  Google Scholar 

  5. Mo Y, Zimmermann AE. Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. Ann Pharmacother. 2013;47(6):869–76.

    Article  PubMed  Google Scholar 

  6. Xiao M, Jiang CF, Gao Q, Pan J, Zhang H, Wu SN, Dou MS. Effect of Dexmedetomidine on cardiac surgery patients. J Cardiovasc Pharmacol. 2023;81(2):104–13.

    Article  CAS  PubMed  Google Scholar 

  7. Tang C, Xia Z. Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic. J Pain Res. 2017;10:1899–904.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Liaquat Z, Xu X, Zilundu PLM, Fu R, Zhou L. The current role of Dexmedetomidine as Neuroprotective Agent: an updated review. Brain Sci. 2021;11(7):846.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cochlane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. 2011 [J/OL] http://handbook-5-1.cochrane.org/

  11. Higgins J, Thompson S, Deeks J. Measuring inconsistency in meta-analyses. BMJ (Clinical Res ed). 2003;327(7414):557–60.

    Article  Google Scholar 

  12. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.

    Article  PubMed  Google Scholar 

  13. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE:an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li J, Ye C, Fang P, Qian J, Shang Z, Liu X. Effects of dexmedetomidine on emergence delirium and electroencephalogram during the recovery period in older patients undergoing lower limb orthopedic surgery: a randomized, double-blind, placebo-controlled clinical trial. Chin Med J (Engl). 2024;137(16):1982–4.

    Article  CAS  PubMed  Google Scholar 

  15. Liu Y, Ma L, Gao M, Guo W, Ma Y. Dexmedetomidine reduces postoperative delirium after joint replacement in elderly patients with mild cognitive impairment. Aging Clin Exp Res. 2016;28(4):729–36.

    Article  PubMed  Google Scholar 

  16. Lv L, Gu Y. Dexmedetomidine potential in attenuating postoperative delirium in elderly patients after total hip joint replacement. Rev Assoc Med Bras (1992). 2022;68(9):1166–71.

    Article  PubMed  Google Scholar 

  17. Mei B, Meng G, Xu G, Cheng X, Chen S, Zhang Y, et al. Intraoperative Sedation with Dexmedetomidine is Superior to Propofol for Elderly patients undergoing hip arthroplasty: a prospective randomized controlled study. Clin J Pain. 2018;34(9):811–7.

    Article  PubMed  Google Scholar 

  18. Mei B, Xu G, Han W, Lu X, Liu R, Cheng X, et al. Perioperative Neurocognitive disorders (PND) Study Group. The benefit of dexmedetomidine on postoperative cognitive function is unrelated to the modulation on peripheral inflammation: a Single-center, prospective, randomized study. Clin J Pain. 2020;36(2):88–95.

    Article  PubMed  Google Scholar 

  19. Shin HJ, Woo Nam S, Kim H, Yim S, Han SH, Hwang JW, 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):164–71.

    Article  CAS  PubMed  Google Scholar 

  20. Ye C, Shen J, Zhang C, Hu C. Impact of intraoperative dexmedetomidine on postoperative delirium and pro-inflammatory cytokine levels in elderly patients undergoing thoracolumbar compression fracture surgery: a prospective, randomized, placebo-controlled clinical trial. Med (Baltim). 2024;103(18):e37931.

    Article  CAS  Google Scholar 

  21. Zhu S, Liu Y, Wang X, Wang L, Li J, Xue X, et al. Different sedation strategies in older patients receiving spinal anesthesia for hip surgery on postoperative delirium: a Randomized Clinical Trial. Drug Des Devel Ther. 2023;17:3845–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hong H, Zhang DZ, Li M, Wang G, Zhu SN, Zhang Y, 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Qureshi O, Arthur ME. Recent advances in predicting, preventing, and managing postoperative delirium. Fac Rev. 2023;12:19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bilotta F, Lauretta MP, Borozdina A, Mizikov VM, Rosa G. Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol. 2013;79(9):1066–76.

    CAS  PubMed  Google Scholar 

  25. Zhang HJ, Ma XH, Ye JB, Liu CZ, Zhou ZY. Systematic review and meta-analysis of risk factor for postoperative delirium following spinal surgery. J Orthop Surg Res. 2020;15(1):509.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sica R, Wilson JM, Kim EJ, Culley DJ, Meints SM, Schreiber KL. The relationship of Postoperative Pain and Opioid Consumption to Postoperative Delirium after spine surgery. J Pain Res. 2023;16:287–94.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Xiao MZ, Liu CX, Zhou LG, Yang Y, Wang Y. Postoperative delirium, neuroinflammation, and influencing factors of postoperative delirium: a review. Med (Baltim). 2023;102(8):e32991.

    Article  CAS  Google Scholar 

  28. Dilmen OK, Meco BC, Evered LA, Radtke FM. Postoperative neurocognitive disorders: a clinical guide. J Clin Anesth. 2024;92:111320.

    Article  PubMed  Google Scholar 

  29. Nassan M, Videnovic A. Circadian rhythms in neurodegenerative disorders. Nat Rev Neurol. 2022;18(1):7–24.

    Article  CAS  PubMed  Google Scholar 

  30. Bellesi M, de Vivo L, Chini M, Gilli F, Tononi G, Cirelli C. Sleep loss promotes astrocytic phagocytosis and microglial activation in mouse cerebral cortex. J Neurosci. 2017;37(21):5263–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Ondze B, Espa F, Dauvilliers Y, Billiard M, Besset A. Sleep architecture, slow wave activity and sleep spindles in mild sleep disordered breathing. Clin Neurophysiol. 2003;114(5):867–74.

    Article  CAS  PubMed  Google Scholar 

  32. Weinstein SM, Poultsides L, Baaklini LR, Mörwald EE, Cozowicz C, Saleh JN, et al. Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors. Br J Anaesth. 2018;120(5):999–1008.

    Article  CAS  PubMed  Google Scholar 

  33. Su C, Ren X, Wang H, Ding X, Guo J. Changing Pain Management Strategy from Opioid-centric towards Improve Postoperative Cognitive Dysfunction with Dexmedetomidine. Curr Drug Metab. 2022;23(1):57–65.

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Jing Sun and Duo Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Critical Care Medicine, Emergency General Hospital, XiBaHe South Road 29, Chaoyang District, Beijing, 100028, PR China

    Jing Sun & Ying Bai

  2. Department of general medicine, Ordos Central Hospital, Ordos School of Clinical Medicine, Inner Mongolia Medical University, 23 Yijinhuoluo West Street, Dongsheng District, Ordos, Inner Mongolia, 017000, PR China

    Duo Wang & Peng Liu

  3. Department of Emergency, Emergency General Hospital, XiBaHe South Road 29, Chaoyang District, Beijing, 100028, PR China

    Yue Zhao, Shufang Wang, Chang Meng & Guobin Miao

  4. Department of Cardiology, Ordos Central Hospital, Ordos School of Clinical Medicine, Inner Mongolia Medical University, 23 Yijinhuoluo West Street, Dongsheng District, Ordos, Inner Mongolia, 017000, PR China

    Duo Wang & Peng Liu

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Contributions

JS, DW and YZ conducted a comprehensive review of the scientific literature and drafted the manuscript. YB provided assistance in the compilation of data. S-FW assisted in the processing of the data and the creation of visual representations. CM, G-BM and PL were instrumental in the conceptualization, design, interpretation of data, revision of the manuscript for critical intellectual content, and supervision of the study. The authors have read and approved the final manuscript.

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Correspondence to Chang Meng, Guobin Miao or Peng Liu.

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Sun, J., Wang, D., Zhao, Y. et al. Intravenous dexmedetomidine for delirium prevention in elderly patients following orthopedic surgery: a meta-analysis of randomized controlled trials. BMC Pharmacol Toxicol 26, 8 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40360-025-00841-2

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BMC Pharmacology and Toxicology

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