Anesth Pain Med > Volume 16(1); 2021 > Article |
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AUTHOR CONTRIBUTIONS
Conceptualization: Jun Mo Lee, Eun Jin Ahn, Geun Joo Choi, Hyun Kang. Data curation: Jun Mo Lee, Hyun Kang. Formal analysis: Ye Jin Cho, Hyun Kang. Funding acquisition: Hyun Kang. Methodology: Geun Joo Choi, Hyun Kang. Project administration: Jun Mo Lee, Ye Jin Cho, Hyun Kang. Visualization: Ye Jin Cho, Geun Joo Choi, Hyun Kang. Writing - original draft: Jun Mo Lee, Ye Jin Cho, Geun Joo Choi, Hyun Kang. Writing - review & editing: Jun Mo Lee, Eun Jin Ahn, Hyun Kang. Investigation: Jun Mo Lee, Ye Jin Cho, Eun Jin Ahn, Hyun Kang. Resources: Jun Mo Lee, Hyun Kang. Software: Hyun Kang. Supervision: Eun Jin Ahn, Geun Joo Choi, Hyun Kang. Validation: Jun Mo Lee, Ye Jin Cho, Eun Jin Ahn, Hyun Kang.
Study | Year | Country | Surgery | Anesthesia | Assessment tool | Assessor | Management | Administraion time | No. of patients | Age (yr) | Sex, M/F (%) |
---|---|---|---|---|---|---|---|---|---|---|---|
Deiner et al. [69] | 2017 | USA | Noncardiac surgery | G/A | CAM, CAM-ICU, MMSE | Trained lay | Dexmedetomidine | Intraop | 147 | 74 | 49/51 |
interviewers | Control | 157 | 74 | 49/51 | |||||||
Djaiani et al. [33] | 2016 | Canada | Cardiac surgery | G/A | CAM, CAM-ICU | Tester | Dexmedetomidine | Postop | 91 | 72.7 | 75/25 |
Propofol | 92 | 72.4 | 76/24 | ||||||||
Susheela et al. [70] | 2017 | USA | Cardiac surgery | G/A | CAM, MMSE | Research members | Dexmedetomidine | Intraop & Postop | 3 | No described (> 60) | No described |
Dexmedetomidine + AAP | 3 | ||||||||||
Propofol | 3 | ||||||||||
Propofol + AAP | 3 | ||||||||||
Li et al. [35] | 2017 | China | Cardiac surgery | G/A | CAM, CAM-ICU | Research members | Dexmedetomidine | Periop | 142 | 66 | 67/30 |
Control | 143 | 68 | 71/29 | ||||||||
Maldonado et al. [4] | 2009 | USA | Cardiac surgery | G/A | CAM, CAM-ICU, DRS | Neuropsychiatrist | Dexmedetomidine | Postop | 40 | 55 | 65/35 |
Propofol | 38 | 58 | 58/42 | ||||||||
Midazolam | 40 | 60 | 68/32 | ||||||||
Park et al. [62] | 2014 | South Korea | Cardiac surgery | G/A | CAM-ICU | Medical staff and non-psychiatrists | Dexmedetomidine | Postop | 67 | 51 | 60/40 |
Remifentanil | 75 | 54 | 55/45 | ||||||||
Shehabi et al. [31] | 2009 | Australia | Cardiac surgery | G/A | CAM-ICU | Nurse and the research team | Dexmedetomidine | No described | 152 | 71 | 75/25 |
Morphine | 147 | 71 | 75/25 | ||||||||
Su et al. [36] | 2016 | China | Noncardiac surgery | G/A, | CAM-ICU | Research members | Dexmedetomidine | Periop | 350 | No described (> 65) | No described |
R/A | Control | 350 | |||||||||
Wu et al. [65] | 2018 | Taiwan | Thoracoscopic surgery | G/A | No described | No described | Dexmedetomidine | Intraop | 30 | 59 | 50/50 |
Control | 3 | 59 | 51/49 | ||||||||
Clemmesen et al. [48] | 2018 | Denmark | Hip fracture surgery | G/A, | CAM | Research members | Methylprednisolone | Preop | 59 | 79 | 37/63 |
R/A | Control | ||||||||||
58 | 81 | 37/63 | |||||||||
de Jonghe et al. [58] | 2014 | Netherland | Hip fracture surgery | No described | DSM-IV | Medical and | Melatonin | Periop | 186 | 84 | 28/72 |
nursing records | Control | 192 | 83 | 32/68 | |||||||
Dieleman et al. [59] | 2012 | Netherland | Cardiac surgery | G/A | No described | No described | Dexamethasone | Intraop | 2,235 | 66 | 73/27 |
Control | 2,247 | 66 | 72/28 | ||||||||
Fukata et al. [54] | 2014 | Japan | Abdominal, orthopedic surgery | G/A, | NEECHAM | Research members | Haloperidol | Postop | 59 | 81 | 50/50 |
R/A | Control | 60 | 80 | 50/50 | |||||||
Gamberini et al. [64] | 2009 | Switzerland | Cardiac surgery | G/A | CAM, MMSE, | Research members | Rivastigmine | Periop | 56 | 74 | 66/34 |
CDT | Control | 57 | 74 | 70/30 | |||||||
Hudetz et al. [71] | 2009 | USA | Cardiac surgery | G/A | ICDSC | Anesthesiologist | Ketamine | Intraop | 29 | 68 | No described |
Control | 29 | 60 | |||||||||
Kalisvaart et al. [60] | 2005 | Netherland | Hip fracture surgery | No described | CAM, DSM-IV,MMSE, DRS-R-98 | Treating | Haloperidol | Periop | 212 | 79 | 19/81 |
surgeons | Control | 218 | 80 | 21/79 | |||||||
Kaneko et al. [55] | 1999 | Japan | Gastrointestinal surgery | G/A | DSM | Medical and | Haloperidol | Postop | 38 | 72 | 60/40 |
nursing records | Control | 40 | 73 | 65/35 | |||||||
Larsen et al. [72] | 2010 | USA | Joint replacement surgery | G/A, | CAM, DSM-IV, MMSE, DRS-R-98 | Trained nurse | Olanzapine | Periop | 196 | 73 | 52/48 |
R/A | Control | 204 | 74 | 40/60 | |||||||
Lee et al. [63] | 2018 | South Korea | Laparoscopic major surgery | G/A | CAM | Psychiatrist | Dexmedetomidine | Intra | 236 | 73 | 45/55 |
Control | 118 | 74 | 43/57 | ||||||||
Leung et al. [73] | 2017 | USA | Spine, joint replacement surgery | G/A, | CAM | Research assistants | Gabapentin | Periop | 350 | 73 | 45/55 |
R/A | Control | 347 | 73 | 55/45 | |||||||
Li et al. [1] | 2017 | China | Spine surgery | G/A | Nu-DESC | Nurse | Nimodipine | Periop | 30 | 69 | 37/63 |
Control | 30 | 70 | 43/57 | ||||||||
Liu et al. [2] | 2016 | China | Joint replacement surgery | G/A | CAM | No described | Dexmedetomidine | Intraop | 60 | 71 | 43/57 |
Control | 58 | 73 | 50/50 | ||||||||
Mardani and Bigdelian [52] | 2013 | Iran | Cardiac surgery | G/A | MMSE, DSM-IV | No described | Dexamethasone | Periop | 43 | 65 | 84/16 |
Control | 50 | 60 | 88/12 | ||||||||
Mohammadi et al. [53] | 2016 | Iran | Noncardiac surgery | No described | CAM-ICU | Anesthesiologist | Cyproheptadine | Postop | 20 | 60 | 60/40 |
Control | 20 | 60 | 70/30 | ||||||||
Papadopoulos et al. [49] | 2014 | Greece | Femoral, femur fracture surgery | G/A | CAM, MMSE | Research members | Ondansetron | Postop | 51 | 72 | No described |
Control | 55 | 71 | |||||||||
Prakanrattana and Prapaitrakool [67] | 2007 | Thailand | Cardiac surgery | G/A | CAM, CAM-ICU | Anesthesiologist | Risperidone | Postop | 63 | 61 | 57/43 |
Control | 63 | 61 | 60/40 | ||||||||
Priye et al. [50] | 2015 | India | Cardiac surgery | G/A | No described | No described | Dexmedetomidine | Postop | 32 | 45 | 51/49 |
Control | 32 | 41 | 50/50 | ||||||||
Robinson et al. [74] | 2014 | USA | Vascular,urologic,thoracic surgery | G/A, | CAM-ICU | Research members | L-tryptophan | Postop | 152 | 69 | 97/1 |
R/A | Control | 149 | 69 | 97/3 | |||||||
Royse et al. [32] | 2017 | Australia | Cardiac surgery | G/A | CAM-ICU | No described | Methylprednisolone | Intraop | 250 | 73 | 63/37 |
Canada | Control | 248 | 74 | 66/34 | |||||||
Sampson et al. [68] | 2007 | UK | THR | No described | DSI | No described | Donepezil | Postop | 19 | 70 | 58/42 |
Control | 14 | 65 | 43/57 | ||||||||
Sheikh et al. [51] | 2018 | India | Cardiac surgery | G/A | No described | No described | Dexmedetomidine | Intraop | 30 | 34 | No described |
Propofol | 30 | 36 | |||||||||
Sugano et al. [56] | 2017 | Japan | GI, lung cancer surgery | G/A | DSM-IV | Physicians | TJ-54 | Periop | 93 | 76 | 65/35 |
Control | 93 | 77 | 65/35 | ||||||||
Wang et al. [37] | 2012 | China | Noncardiac surgery | G/A, | CAM-ICU | Research members | Haloperidol | Postop | 229 | 74 | 63/37 |
R/A | Control | 228 | 74 | 63/37 | |||||||
Whitlock et al. [34] | 2015 | Canada | Cardiac surgery | G/A | CAM | Outcome | Methylprednisolone | Intraop | 3,755 | 68 | 60/40 |
adjudicators | Control | 3,752 | 67 | 61/39 | |||||||
Yang et al. [38] | 2015 | China | Free flap surgery | G/A | CAM-ICU | Investigator | Dexmedetomidine | Periop | 39 | 50 | 50/50 |
Control | 40 | 50 | 50/50 | ||||||||
He et al. [6] | 2018 | China | Vertebral osteotomy | G/A | CAM | No described | Dexmedetomidine | Periop | 30 | 83 | 53/47 |
Midazolam | 30 | 82 | 63/37 | ||||||||
Control | 30 | 83 | 56/44 | ||||||||
Ma et al. [39] | 2013 | China | Orthopedic surgery | G/A | CAM | Research members | Ketamine | Periop | 30 | 66 | 53/47 |
Dexmedetomidine | 30 | 69 | 34/66 | ||||||||
Ketamine + Dexemetomidine | 30 | 66 | 40/60 | ||||||||
Control | 30 | 68 | 60/40 | ||||||||
Xuan et al. [40] | 2018 | China | Joint replacement surgery | No described | CAM, CAM-ICU | Research members | Dexmedetomidine | Postop | 227 | 67 | 42/58 |
Control | 226 | 67 | 45/55 | ||||||||
Sauër et al. [61] | 2014 | Netherland | Cardiac surgery | G/A | CAM, CAM-ICU | Research nurse | Dexamethasone | Intraop | 367 | 67 | 70/30 |
Control | 370 | 66 | 69/31 | ||||||||
Huyan et al. [41] | 2019 | China | Radical pulmonary resection | G/A | ICDSC | No described | Dexmedetomidine | Periop | 173 | 71 | 51/49 |
Control | 173 | 72 | 54/46 | ||||||||
Shi et al. [42] | 2019 | China | Cardiac surgery | G/A | CAM | Research members | Dexmedetomidine | Intraop | 84 | 75 | 75/25 |
Propofol | 80 | 74 | 70/30 | ||||||||
Liu et al. [43] | 2016 | China | Cardiac surgery | G/A | CAM | No described | Dexmedetomidine | Postop | 44 | 53 | 52/48 |
Propofol | 44 | 57 | 68/32 | ||||||||
Mei et al. [44] | 2018 | China | Hip arthroplasty | R/A | CAM | Research members | Dexmedetomidine | Intraop | 148 | 76 | 43/57 |
Propofol | 148 | 74 | 48/52 | ||||||||
Guo et al. [45] | 2015 | China | Oral cancer surgery | G/A | CAM-ICU | No described | Dexmedetomidine | Postop | 78 | 72 | 53/47 |
Control | 78 | 71 | 50/50 | ||||||||
Aizawa et al. [57] | 2002 | Japan | GI surgery | G/A | DSM-IV | Psychiatrist | Diazepam + Flunitrazepam + Pethidine (DFP) | Postop | 20 | 76 | 75/25 |
Control | |||||||||||
20 | 76 | 55/45 | |||||||||
Mu et al. [46] | 2017 | China | Joint replacement surgery | R/A | CAM, CAM-ICU | Research members | Parecoxib | No described | 310 | 70 | 26/74 |
Control | 310 | 71 | 27/73 | ||||||||
Sultan [77] | 2010 | Saudi Arabia | Hip arthroplasty | R/A | AMT | Resident anesthetist | Melatonin | Preop | 53 | 70 | 45/55 |
Midazolam | 50 | 70 | 52/48 | ||||||||
Clonidine | 51 | 72 | 53/47 | ||||||||
Control | 49 | 72 | 45/55 | ||||||||
Liptzin et al. [75] | 2005 | USA | Joint replacement surgery | No described | CAM, DSM-IV, | Research members | Donepezil | Periop | 39 | 67 | 36/64 |
DSI | Control | 41 | 68 | 49/51 | |||||||
Leung et al. [76] | 2006 | USA | Spine surgery | G/A | CAM | Research members | Gabapentin | Periop | 9 | 57 | 44/56 |
Control | 12 | 61 | 58/42 | ||||||||
Liu et al. [47] | 2016 | China | Cardiac surgery | G/A | CAM | No described | Dexmedetomidine | Postop | 29 | 53 | 34/66 |
Propofol | 32 | 55 | 47/53 | ||||||||
Chang et al. [66] | 2018 | Taiwan | GI surgery | G/A | CAM | No described | Dexmedetomidine | Postop | 31 | 71 | 61/39 |
Propofol | 29 | 70 | 55/45 |
CAM: confusion assessment method, CAM-ICU: confusion assessment method for intensive care unit, MMSE: mini-mental state examination, DRS: delirium rating scale, DSM-IV: diagnostic and statistical manual of mental disorders-IV, NEECHAM: neelon and champagne confusion scale, CDT: clock drawing test, ICDSC: intensive care delirium screening checklist, DRS-R-98: delirium rating scale-revised-98, Nu-DESC: nursing delirium screening score, DSI: delirium symptom interview, AMT: appreviated mental test, Intraop: intra-operative, Periop: peri-operative, Preop: pre-operative, G/A: general anesthesia, R/A: regional anesthesia, THR: total hip replacement, GI: gastro-intestinal.
Study | Bias arising from the randomization process | Bias due to deviations from intended interventions | Bias due to missing outcome data | Bias in measurement of the outcome | Bias in selection of the reported result | Overall risk of bias judgement |
---|---|---|---|---|---|---|
Deiner et al., 2017 [69] | Low risk | Some concerns | Low risk | Low risk | Low risk | Some concerns |
Djaiani et al., 2016 [33] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Susheela et al., 2017 [70] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Li et al., 2017 [35] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Maldonado et al., 2009 [4] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Park et al., 2014 [62] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Shehabi et al., 2009 [31] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Su et al., 2016 [36] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Wu et al., 2018 [65] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Clemmesen et al., 2018 [48] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
de Jonghe et al., 2014 [58] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Dieleman et al., 2012 [59] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Fukata et al., 2014 [54] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Gamberini et al., 2009 [64] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Hudetz et al., 2009 [71] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Kalisvaart et al., 2005 [60] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Kaneko et al., 1999 [55] | Low risk | Some concerns | Low risk | Low risk | Low risk | Some concerns |
Larsen et al., 2010 [72] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Lee et al., 2018 [63] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Leung et al., 2017 [73] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Li et al., 2017 [1] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Liu et al., 2016 [2] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Mardani and Bigdelian, 2013 [52] | Some concerns | Some concerns | Some concerns | Low risk | Low risk | High risk |
Mohammadi et al., 2016 [53] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Papadopoulos et al., 2014 [49] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Prakanrattana and Prapaitrakool, 2007 [67] | Low risk | Some concerns | Low risk | Low risk | Low risk | Some concerns |
Priye et al., 2015 [50] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Robinson et al., 2014 [74] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Royse et al., 2017 [32] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Sampson et al., 2007 [68] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Sheikh et al., 2018 [51] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Sugano et al., 2017 [56] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Wang et al., 2012 [37] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Whitlock et al., 2015 [34] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Yang et al., 2015 [38] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
He et al., 2018 [6] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Ma et al., 2013 [39] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Xuan et al., 2018 [40] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Sauër et al., 2014 [61] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Huyan et al., 2019 [41] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Shi et al., 2019 [42] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Liu et al., 2016 [43] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Mei et al., 2018 [44] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Guo et al., 2015 [45] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Aizawa et al., 2002 [57] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Mu et al., 2017 [46] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Sultan, 2010 [77] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Liptzin et al., 2005 [75] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Leung et al.,2006 [76] | Some concerns | Some concerns | Low risk | Low risk | Low risk | High risk |
Liu et al., 2016 [47] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Chang et al., 2018 [66] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |