Evidence map›Paper›PMID 40888048›Full record

SynthesisAnaesthesia2026

Effect of peri-operative pharmacological interventions on postoperative delirium in patients having cardiac surgery: a systematic review and Bayesian network meta-analysis.

Ivo Queiroz, Lucas M Barbosa, Mariano Gallo Ruelas, Beatriz Araújo, Maria L R Defante, Arthur H Tavares, Cynthia Florencio de Mesquita, Tulio Pimentel, Beatriz Ximenes Mendes, Iuri Ferreira Felix and 7 more

Abstract readNetwork Meta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Review
  6. Review
  7. Article
  8. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Ivo QueirozDepartment of Medicine, APAMI Hospital, Vitória de Santo Antão, Brazil.ORCID 0009-0001-6544-8450
Lucas M BarbosaDepartment of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Mariano Gallo RuelasDepartment of Nutrition Sciences, Instituto de Investigación Nutricional, Lima, Peru.
Beatriz AraújoDepartment of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil.
Maria L R DefanteDepartment of Medicine, Redentor University Center, Rio de Janeiro, Brazil.
Arthur H TavaresDepartment of Medicine, University of Pernambuco, Recife, Brazil.
Cynthia Florencio de MesquitaDepartment of Medicine, Federal University of Pernambuco, Recife, Brazil.
Tulio PimentelDepartment of Medicine, Federal University of Pernambuco, Recife, Brazil.
Beatriz Ximenes MendesDepartment of Medicine, Unichristus, Fortaleza, Brazil.
Iuri Ferreira FelixDepartment of Medicine, Mayo Clinic, Rochester, MN, USA.
André RiveraDepartment of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil.
Rafael Oliva Morgado FerreiraDepartment of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil.
Helen M de OliveiraDepartment of Medicine, Federal University of Mato Grosso, Sinop, Brazil.
Bruno B RighettoDepartment of Medicine, University Positivo, Valinhos, Brazil.
Nathan J SmischneyDepartment of Medicine, Mayo Clinic, Rochester, MN, USA.
Guangyu TongDepartment of Medicine, Yale School of Medicine, New Haven, CT, USA.
Daqing MaDepartment of Anesthesiology, Zhejiang University School of Medicine Children's Hospital, Hangzhou, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPostoperative delirium is a common complication following cardiac surgery. Despite its known impact on patient outcomes, effective preventative strategies remain elusive. We aimed to perform a comprehensive Bayesian network meta-analysis of randomised controlled trials assessing the effect of pharmacological interventions on the incidence of postoperative delirium.

methodsDatabases were searched from inception to September 2024. Our search was updated in January 2025. Eligible studies included randomised controlled trials reporting the incidence of postoperative delirium in patients having cardiac surgery treated with pharmacological interventions. Bayesian models were used to estimate risk ratios (RR) and mean differences with 95%CrI through Markov chain Monte Carlo. Interventions were ranked using the surface under the cumulative ranking curve. Sensitivity analyses and grading of recommendations, assessment, development and evaluation assessment were conducted to evaluate the robustness and certainty of evidence.

resultsSeventy-nine randomised controlled trials comprising 24,827 patients were included, with 29 pharmacological interventions compared. Dexmedetomidine combined with melatonin was the most effective intervention, reducing the incidence of postoperative delirium compared with placebo (risk ratio 0.31, 95%CrI 0.13-0.69; low certainty). Dexmedetomidine with melatonin also significantly decreased intensive care unit stay (2.4 days, 95%CrI -3.50-1.10) and hospital stay (1.32 days, 95%CrI -2.09 to -0.57). Other interventions, including ketamine and risperidone, showed potential efficacy but with low or very low certainty of evidence. DISCUSSION: We identified dexmedetomidine with melatonin as the most effective pharmacological strategy for preventing postoperative delirium following cardiac surgery. Whilst these findings highlight potential benefits, the low certainty of evidence underscores the need for more high-quality primary evidence.

Indexed as

Cardiac Surgical ProceduresDeliriumEmergence DeliriumPerioperative CarePostoperative ComplicationsBayes TheoremDexmedetomidineHumansMelatoninNetwork Meta-Analysis as TopicRandomized Controlled Trials as TopicDexmedetomidineMelatonindexmedetomidinemelatoninpostoperative cognitive dysfunctionpostoperative deliriumsystematic review cardiac surgery

Identifiers

PMID40888048
PMCPMC12803695

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.