O impacto de diferentes métodos de intervenção (medicamentos anestésicos adjuvantes, técnicas anestésicas e intervenções não farmacológicas) na função cognitiva pós-operatória em pacientes submetidos à cirurgia cardíaca: revisão sistemática e metanálise da rede bayesiana

Resumo original em inglês

O que aconteceu

Postoperative cognitive dysfunction (POCD) is a frequent complication after cardiac surgery, with inconsistent evidence regarding preventive strategies. This network meta-analysis aims to evaluate and compare multiple interventions to establish an evidence-based framework for optimizing clinical management.

A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted for randomized controlled trials (RCTs) involving patients undergoing cardiac surgery. The study, adhering to PRISMA-NMA guidelines, included various interventions such as anesthetic agents, adjunctive drugs, and cognitive training. Methodological quality was assessed using the Cochrane Risk of Bias tool. We performed a Bayesian network meta-analysis. Rankings were interpreted according to the prespecified favorable outcome direction; therefore, lower SUCRA values denoted greater preventive effectiveness.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251128365, identifier (CRD420251128365).

O que encontraram

The analysis included 46 RCTs, encompassing 9,928 patients and 20 different intervention strategies. Most studies demonstrated a low risk of bias. Because POD and POCD were adverse-event incidence outcomes and MMSE change was coded so that smaller unfavorable postoperative decline represented benefit, lower SUCRA values were interpreted as indicating greater intervention effectiveness. Intranasal insulin, gastrodin, and cognitive training showed the lowest SUCRA values for POD-related outcomes. Gastrodin, esketamine, and dexmedetomidine showed the lowest SUCRA values for POCD-related outcomes. MMSE-change rankings were interpreted cautiously because they were based on fewer studies and were sensitive to the coding direction of change scores.

Por que isso importa

This network meta-analysis suggests that intranasal insulin, gastrodin, cognitive training, esketamine, and dexmedetomidine may reduce POD or POCD after cardiac surgery. However, the comparative rankings are uncertain for interventions supported by few studies, and the MMSE-change findings remain exploratory. Further high-quality RCTs are required to confirm these results.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.