***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : The purpose of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in postcardiac surgery patients . Setting s and Design : A prospect i ve , r and omized , double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass . Interventions : Sixty-four patients who underwent elective cardiac surgery under general anesthesia were shifted to intensive care unit ( ICU ) and r and omly divided into two groups . Group A ( n = 32 ) received a 12 h infusion of normal saline and group B ( n = 32 ) received a 12 h infusion of dexmedetomidine 0.4 μg/kg/h . Postoperative pain was managed with bolus intravenous fentanyl . Total fentanyl consumption , hemodynamic monitoring , Visual Analogue Scale ( VAS ) pain ratings , Ramsay Sedation Scale were charted every 6 th hourly for 24 h postoperatively and followed-up till recovery from ICU . Student′s t-test , Chi-square/Fisher′s exact test has been used to find the significance of study parameters between the groups . Results : Dexmedetomidine treated patients had significantly less VAS score at each level ( P < 0.001 ) . Total fentanyl consumption  in dexmedetomidine group was 128.13 ± 35.78 μg versus 201.56 ± 36.99 μg in saline group ( P < 0.001 ) . A statistically significant but clinical ly unimportant sedation was noted at 6 and 12 h ( P < 0.001 , and P = 0.046 respectively ) . Incidence of delirium was less in dexmedetomidine group ( P = 0.086 + ) . Hemodynamic parameters were statistically insignificant . Conclusions : Dexmedetomidine infusion even without loading dose provides safe , effective adjunct analgesia , reduces narcotic consumption , and showed a reduced trend of delirium incidence without undesirable hemodynamic effects in the cardiac surgery patients Background Delirium after cardiac surgery is associated with serious long-term negative outcomes and high costs . The aim of this study is to evaluate neurobehavioral , hemodynamic , and sedative characteristics of dexmedetomidine , compared with the current postoperative sedative protocol ( remifentanil ) in patients undergoing open heart surgery with cardiopulmonary bypass ( CPB ) . Methods One hundred and forty two eligible patients who underwent cardiac surgery on CPB between April 2012 and March 2013 were r and omly divided into two groups . Patients received either dexmedetomidine ( range , 0.2 to 0.8 μg/kg/hr ; n=67 ) or remifentanil ( range , 1,000 to 2,500 μg/hr , n=75 ) . The primary end point was the prevalence of delirium estimated daily via the confusion assessment method for intensive care . Results When the delirium incidence was compared with the dexmedetomidine group ( 6 of 67 patients , 8.96 % ) and the remifentanil group ( 17 of 75 patients , 22.67 % ) it was found to be significantly less in the dexmedetomidine group ( p<0.05 ) . There were no statistically significant differences between two groups in the extubation time , ICU stay , total hospital stay , and other postoperative complications including hemodynamic side effects . Conclusion This preliminary study suggests that dexmedetomidine as a postoperative sedative agent is as sociated with significantly lower rates of delirium after cardiac surgery BACKGROUND Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances . OBJECTIVE The authors investigated the effects of postoperative sedation on the development of delirium in patients undergoing cardiac-valve procedures . METHODS Patients underwent elective cardiac surgery with a st and ardized intraoperative anesthesia protocol , followed by r and om assignment to one of three postoperative sedation protocol s : dexmedetomidine , propofol , or midazolam . RESULTS The incidence of delirium for patients receiving dexmedetomidine was 3 % , for those receiving propofol was 50 % , and for patients receiving midazolam , 50 % . Patients who developed postoperative delirium experienced significantly longer intensive-care stays and longer total hospitalization . CONCLUSION The findings of this open-label , r and omized clinical investigation suggest that postoperative sedation with dexmedetomidine was associated with significantly lower rates of postoperative delirium and lower care costs Background : Commonly used sedatives/analgesics can increase the risk of postoperative complications , including delirium . This double-blinded study assessed the neurobehavioral , hemodynamic , and sedative characteristics of dexmedetomidine compared with morphine-based regimen after cardiac surgery at equivalent levels of sedation and analgesia . Methods : A total of 306 patients at least 60 yr old were r and omized to receive dexmedetomidine ( 0.1–0.7 & mgr;g · kg−1 · h−1 ) or morphine ( 10 - 70  &  mgr;g  · kg−1 · h−1 ) with open-label propofol titrated to a target Motor Activity Assessment Scale of 2–4 . Primary outcome was the prevalence of delirium measured daily via Confusion Assessment Method for intensive care . Secondary outcomes included ventilation time , additional sedation/analgesia , and hemodynamic and adverse effects . Results : Of all sedation assessment s , 75.2 % of dexmedetomidine and 79.6 % ( P = 0.516 ) of morphine treatment were in the target range . Delirium incidence was comparable between dexmedetomidine 13 ( 8.6 % ) and morphine 22 ( 15.0 % ) ( relative risk 0.571 , 95 % confidence interval [ CI ] 0.256–1.099 , P = 0.088 ) , however , dexmedetomidine-managed patients spent 3 fewer days ( 2 [ 1–7 ] versus 5 [ 2–12 ] ) in delirium ( 95 % CI 1.09–6.67 , P = 0.0317 ) . The incidence of delirium was significantly less in a small subgroup requiring intraaortic balloon pump and treated with dexmedetomidine ( 3 of 20 [ 15 % ] versus 9 of 25 [ 36 % ] ) ( relative risk 0.416 , 95 % CI 0.152–0.637 , P = 0.001 ) . Dexmedetomidine-treated patients were more likely to be extubated earlier ( relative risk 1.27 , 95 % CI 1.01–1.60 , P = 0.040 , log-rank P = 0.036 ) , experienced less systolic hypotension ( 23 % versus 38.1 % , P = 0.006 ) , required less norepinephrine ( P < 0.001 ) , but had more bradycardia ( 16.45 % versus 6.12 % , P = 0.006 ) than morphine treatment . Conclusion : Dexmedetomidine reduced the duration but not the incidence of delirium after cardiac surgery with effective analgesia/sedation , less hypotension , less vasopressor requirement , and more bradycardia versus morphine regimen Background : Postoperative delirium ( POD ) is a serious complication after cardiac surgery . Use of dexmedetomidine to prevent delirium is controversial . The authors hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD . Methods : After institutional ethics review board approval , and informed consent , a single-blinded , prospect i ve , r and omized controlled trial was conducted in patients 60 yr or older undergoing cardiac surgery . Patients with a history of serious mental illness , delirium , and severe dementia were excluded . Upon admission to intensive care unit ( ICU ) , patients received either dexmedetomidine ( 0.4 & mgr;g/kg bolus followed by 0.2 to 0.7 & mgr;g kg−1 h−1 infusion ) or propofol ( 25 to 50 & mgr;g kg−1 min−1 infusion ) according to a computer-generated r and omization code in blocks of four . Assessment of delirium was performed with confusion assessment method for ICU or confusion assessment method after discharge from ICU at 12-h intervals during the 5 postoperative days . Primary outcome was the incidence of POD . Results : POD was present in 16 of 91 ( 17.5 % ) and 29 of 92 ( 31.5 % ) patients in dexmedetomidine and propofol groups , respectively ( odds ratio , 0.46 ; 95 % CI , 0.23 to 0.92 ; P = 0.028 ) . Median onset of POD was on postoperative day 2 ( 1 to 4 days ) versus 1 ( 1 to 4 days ) , P = 0.027 , and duration of POD 2 days ( 1 to 4 days ) versus 3 days ( 1 to 5 days ) , P = 0.04 , in dexmedetomidine and propofol groups , respectively . Conclusions : When compared with propofol , dexmedetomidine sedation reduced incidence , delayed onset , and shortened duration of POD  in elderly patients after cardiac surgery .  The absolute risk reduction for POD was 14 % , with a number needed to treat of 7.1 OBJECTIVE The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine ( Dex ) on outcomes for older patients undergoing cardiac surgery . DESIGN Retrospective investigation . SETTING Patients from a single tertiary medical center . PARTICIPANTS A total of 505 patients ( ≥65 years old ) who underwent coronary artery bypass graft ( CABG ) or valve surgery . CABG and /or valve surgery plus other procedures were divided into 2 groups : 283 received intravenous Dex infusion ( Dex group ) and 222 did not ( Non-Dex group ) . INTERVENTIONS Perioperative Dex intravenous infusion ( 0.24 to 0.6 μg/kg/h ) initiated after cardiopulmonary bypass and continued for<24 hours postoperatively in the ICU . MEASUREMENTS AND MAIN RESULTS Data were risk adjusted , propensity score weighted , and multivariate logistic regression was used . The primary outcome was mortality . Secondary outcomes included postoperative stroke , coma , myocardial infa rct ion , heart block , cardiac arrest , delirium , renal failure , and sepsis . Perioperative Dex infusion significantly decreased in-hospital mortality ( 0.90 % v 2.83 % ; adjusted odds ratio ( OR ) , 0.099 ; 95 % confidence interval ( CI ) , 0.030 - 0.324 ; p = 0.004 ) and operative mortality ( 1.35 % v 3.18 % ; adjusted OR , 0.251 ; 95 % CI , 0.077 - 0.813 ; p = 0.021 ) . Perioperative Dex treatment also reduced the risk of stroke ( 0.90 % v 1.77 % ; adjusted OR , 0.15 ; 95 % CI , 0.038 - 0.590 ; p = 0.007 ) , and delirium ( 7.21 % v 10.95 % ; adjusted OR , 0.35 ; 95 % CI , 0.212 - 0.578 ; p < 0.0001 ) . CONCLUSIONS Results from this study ( Clinical Trials.gov identifier : NCT01683448 ) suggested perioperative use of dexmedetomidine was associated with decreases in in-hospital and operative mortality in elderly patients following cardiac surgery . It also reduced incidences of postoperative stroke and delirium in elderly patients BACKGROUND Delirium or acute confusion is a temporary mental disorder , which occurs frequently among hospitalized elderly patients . Patients who undergo cardiac surgery have an increased risk of developing delirium . This is associated with many negative consequences such as prolonged hospital stay , nursing home placement , and reduced cognitive and functional recovery . METHODS In this prospect i ve follow-up study , a question naire was used 1 to 1.5 years after  cardiac surgery  in our earlier cohort of 112 patients who underwent elective cardiac surgery  , of which 24 patients ( 21 % ) developed postoperative delirium  as diagnosed by a single psychiatrist . RESULTS Postoperative delirium after cardiac surgery may be associated with increased mortality ( 12.5 % in patients with delirium versus 4.5 % in patients without delirium ; p = 0.16 ) , more readmissions to the hospital ( 47.6 % vs 32.6 % ; p = 0.19 ) , dysfunction in memory ( 31.6 % vs 22.6 % ; p = 0.39 ) , and concentration problems 
    Output:
    
Postoperative use of dexmedetomidine in cardiac surgery patients may reduce the incidence of postoperative delirium