Introduction: Cardiac surgery is associated with substantial oxidative stress due to surgical trauma, cardiopulmonary bypass, and ischemia–reperfusion injury, which may contribute to postoperative organ dysfunction. Dexmedetomidine has shown potential antioxidative and organ-protective effects. Therefore, this study aimed to systematically review the effect of intraoperative intravenous dexmedetomidine on oxidative stress in patients undergoing cardiac surgery.

Material and methods: This systematic review followed PRISMA guidelines to identify clinical studies on intraoperative intravenous dexmedetomidine and oxidative stress in cardiac surgery. Multiple databases were searched without time limits by two independent reviewers using Boolean-based keywords. Eligible studies were screened, quality-assessed with the Cochrane Risk of Bias tool, and relevant study, patient, intervention, and outcome data were extracted.

Results: Across clinical and experimental cardiopulmonary bypass-related settings, intraoperative intravenous dexmedetomidine showed a broadly protective profile. It attenuated perioperative stress responses, reduced selected markers of myocardial injury and inflammation, improved hemodynamic and recovery outcomes, and lowered postoperative atrial fibrillation. Experimental evidence further indicated direct cardiomyocyte protection through antioxidant, antiapoptotic, autophagy-regulating, electrophysiological, and transcriptional mechanisms.

Conclusion: The available evidence suggests that intraoperative intravenous dexmedetomidine may mitigate oxidative stress-related injury during cardiac surgery through both systemic and cellular mechanisms. Its benefits appear to include attenuation of surgical stress, reduction of selected inflammatory and myocardial injury markers, and improvement in postoperative recovery. These findings support dexmedetomidine as a promising cardioprotective adjunct in cardiac surgical care.