Background: Dexmedetomidine, a highly selective α2-adrenergic receptor agonist, may help mitigate postoperative complications in patients undergoing aortic vascular surgery. Methodology: A comprehensive search was conducted across PubMed, the Cochrane Library, and Embase to identify studies assessing the efficacy and safety of dexmedetomidine compared with placebo in patients undergoing aortic vascular surgery. A random effects meta-analysis was performed with R version 4.4.1 using the “meta” package. Results: Our analysis included eleven studies, comprising eight RCTs and three cohort studies, with a combined total of 1731 patients. The results showed that dexmedetomidine significantly reduced acute kidney injury (OR 0.49, 95% CI 0.25 to 0.98), ICU length of stay (MD −0.25 days, 95% CI −0.47 to −0.02), postoperative pulmonary complications (OR 0.55, 95% CI 0.32 to 0.94), and CRP levels 24 h post-surgery (MD −24.73 mg/L, 95% CI −46.29 to −3.16) compared to the control group. The length of hospital stay (MD -0.87 days, 95% CI −2.57 to 1.01), postoperative delirium (OR 0.78, 95% CI 0.43 to 1.42), and in-hospital mortality (OR 0.57, 95% CI 0.29 to 1.12) were not significantly different between the two groups. Conclusion: In patients undergoing aortic vascular surgery, dexmedetomidine administration is associated with reduced acute kidney injury, length of ICU stay, postoperative pulmonary complications, and CRP levels 24 h post-surgery.
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