Effect of Preoperative Dexmedetomidine on Prevalence of Postoperative Cognitive Dysfunction in Elderly Patients Candidate for Orthopedic Surgery under General Anesthesia
Abstract
Background: Postoperative cognitive dysfunction (POCD) is amongst the most critical complications after surgery. This study shows the effect of dexmedetomidine on the prevalence of postoperative cognitive impairment.
Methods: In this double-blinded clinical trial study, patients aged 60-80 years undergoing pelvic and femoral orthopedic surgery were randomly assigned in one of the two groups of the course, i.e., Dexmedetomidine (DEX) or normal saline (NS). We infuse One hour before anesthesia, one µg/kg dexmedetomidine in the group (DEX), and the same volume of normal saline (NS). Mini-Mental State Examination test (MMSE) was applied to evaluate the patients' cognitive condition, One day before the surgery, 24 and 72 hours after the surgery.
Results: There was no significant difference between the two groups in terms of age, sex, duration of anesthesia, duration of surgery, and the amount of bleeding during operation (P>0.0). The postoperative hematocrit level was lower than the preoperative level in the group (DEX) (P<0.05). There was no significant difference in MMSE test scores pre and postoperatively between the two groups (P>0.05).
Conclusion: Dexmedetomidine infused before surgery has no preventive effect on POCD in elderly patients undergoing pelvic and femoral orthopedic surgery under general anesthesia.
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[4] Kuhmonen J, Haapalinna A, Sivenius J. Effects of dexmedetomidine after transient and permanent occlusion of the middle cerebral artery in the rat. J Neural Transm (Vienna) 2001; 108(3): 261-71.
[5] Taniguchi T, Kidani Y, Kanakura H, Takemoto Y, Yamamoto K. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin induced shock in rats. Crit Care Med. 2004; 32(6): 1322-6.
[6] Sezer A, Memis D, Usta U, Süt N. The effect of dexmedetomidine on liver histopathology in a rat sepsis model: an experimental pilot study. Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 108–12.
[7] Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction. Lancet. 1998; 351(9106): 857-61.
[8] Rasmussen LS. Defining postoperative cognitive dysfunction. Eur J Anaesthesiol 1998; 15(6): 761-4.
[9] Guo Y, Sun L, Zhang J, Li Q, Jiang H, Jiang W. Preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients. Int J Clin Exp Med. 2015; 8(9):16183–16190.
[10] Zhang XD, Pu MH, Wang YJ, Feng C. Influence of sub-anesthetic dose of ketamine and dexmedetomidine on early postoperative cognitive function in elderly orthopedic patients under total intravenous anesthesia. Journal of Jilin University (Medicine Edition) 2013; 39: 133–137.
[11] Zhou C, Zhu Y, Liu Z, Ruan L. Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis. J Int Med Res. 2016; 44(6):1182-1190.
[12] Chen J, Yan J and Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp Ther Med. 2013; 5(2): 489-494.
[13] Gong Z, Li J, Zhong Y, Guan X, Huang A, Ma L. Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting. Exp Ther Med. 2018; 16(6):4685-4689.
[14] Mohamed S, Shaaban AR. The effect of dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery. Egyptian Journal of Anaesthesia. 2014; 30(4):331-8.
[15] Ding L, Zhang H, Mi W, Wang T, He Y, Zhang X, et al. Effects of dexmedetomidine on anesthesia recovery period and postoperative cognitive function of patients after robot-assisted laparoscopic radical cystectomy. Int J Clin Exp Med. 2015; 8: 11388–11395.
[16] Chen W, Liu B, Zhang F, Xue P, Cui R, Lei W. The effects of dexmedetomidine on post-operative cognitive dysfunction and inflammatory factors in senile patients. Int J Clin Exp Med. 2015; 8(3): 4601–5.
[17] Yiping Bai, Hong Yu, Maohua Wang, Yunqiang Wan, Xueru Liu, Ni Tang, et al. Effect of intraoperative application of dexmedetomidine on early postoperative cognitive function and serum brain-derived neurotrophic factor (BDNF) in children undergoing tonsillectomy. Int J Clin Exp Med. 2016; 9(5):8482-8489.
[18] Li Y, He R, Chen S, Qu Y. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp Ther Med. 2015; 10(5):1635-1642.
[19] Taban H, Ahmadzadeh G, Tavasoli M. Cognitive impairment in elderly, before and after surgery. Hormozgan Medical Journal. 2003; 7(3):135-9.
[20] Naghibi K, Shetabi H, Nasrollahi K, Mansouri N. The Effect of Intravenous Midazolam and Dexmedetomidine on Prevention of Cognitive Dysfunction after Cataract Surgery in the Elderly Patients under General Anesthesia Compared with the Control Group. J Isfahan Med Sch 2019; 36(504): 1395-400.
[21] Rajaei M, Tabari M, Soltani G, Alizadeh K, Nazari A, Noroozian M, Morovatdar N. Comparison between the Effects of Dexmedetomidine and Midazolam on Postoperative Cognitive Impairment after Coronary Artery Bypasses Graft Surgery: A Randomized Clinical Trial. J Tehran Heart Cent. 2019; 14(2):67-73.
[22] Cheung CW, Ying CL, Chiu WK, Wong GT, Ng KF, Irwin MG. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia. 2007; 62(11):1132-8.
[23] Mansouri N, Nasrollahi K, Shetabi H. Prevention of Cognitive Dysfunction after Cataract Surgery with Intravenous Administration of Midazolam and Dexmedetomidine in Elderly Patients Undergoing Cataract Surgery. Adv Biomed Res. 2019; 8(1):6.
[2] Sanders RD, Xu J, Shu Y, Januszewski A, Halder S, Fidalgo A, et al. Dexmedetomidine attenuates isoflurane induced neurocognitive impairment in neonatal rats. Anesthesiology. 2009; 110: 1077-85.
[3] Goyagi T, Nishikawa T, Tobe Y, Masaki Y. The combined neuroprotective effects of lidocaine and dexmedetomidine after transient forebrain ischemia in rats. Acta Anaesthesiol Scand. 2009; 53(9): 1176-83.
[4] Kuhmonen J, Haapalinna A, Sivenius J. Effects of dexmedetomidine after transient and permanent occlusion of the middle cerebral artery in the rat. J Neural Transm (Vienna) 2001; 108(3): 261-71.
[5] Taniguchi T, Kidani Y, Kanakura H, Takemoto Y, Yamamoto K. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin induced shock in rats. Crit Care Med. 2004; 32(6): 1322-6.
[6] Sezer A, Memis D, Usta U, Süt N. The effect of dexmedetomidine on liver histopathology in a rat sepsis model: an experimental pilot study. Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 108–12.
[7] Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction. Lancet. 1998; 351(9106): 857-61.
[8] Rasmussen LS. Defining postoperative cognitive dysfunction. Eur J Anaesthesiol 1998; 15(6): 761-4.
[9] Guo Y, Sun L, Zhang J, Li Q, Jiang H, Jiang W. Preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients. Int J Clin Exp Med. 2015; 8(9):16183–16190.
[10] Zhang XD, Pu MH, Wang YJ, Feng C. Influence of sub-anesthetic dose of ketamine and dexmedetomidine on early postoperative cognitive function in elderly orthopedic patients under total intravenous anesthesia. Journal of Jilin University (Medicine Edition) 2013; 39: 133–137.
[11] Zhou C, Zhu Y, Liu Z, Ruan L. Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis. J Int Med Res. 2016; 44(6):1182-1190.
[12] Chen J, Yan J and Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp Ther Med. 2013; 5(2): 489-494.
[13] Gong Z, Li J, Zhong Y, Guan X, Huang A, Ma L. Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting. Exp Ther Med. 2018; 16(6):4685-4689.
[14] Mohamed S, Shaaban AR. The effect of dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery. Egyptian Journal of Anaesthesia. 2014; 30(4):331-8.
[15] Ding L, Zhang H, Mi W, Wang T, He Y, Zhang X, et al. Effects of dexmedetomidine on anesthesia recovery period and postoperative cognitive function of patients after robot-assisted laparoscopic radical cystectomy. Int J Clin Exp Med. 2015; 8: 11388–11395.
[16] Chen W, Liu B, Zhang F, Xue P, Cui R, Lei W. The effects of dexmedetomidine on post-operative cognitive dysfunction and inflammatory factors in senile patients. Int J Clin Exp Med. 2015; 8(3): 4601–5.
[17] Yiping Bai, Hong Yu, Maohua Wang, Yunqiang Wan, Xueru Liu, Ni Tang, et al. Effect of intraoperative application of dexmedetomidine on early postoperative cognitive function and serum brain-derived neurotrophic factor (BDNF) in children undergoing tonsillectomy. Int J Clin Exp Med. 2016; 9(5):8482-8489.
[18] Li Y, He R, Chen S, Qu Y. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp Ther Med. 2015; 10(5):1635-1642.
[19] Taban H, Ahmadzadeh G, Tavasoli M. Cognitive impairment in elderly, before and after surgery. Hormozgan Medical Journal. 2003; 7(3):135-9.
[20] Naghibi K, Shetabi H, Nasrollahi K, Mansouri N. The Effect of Intravenous Midazolam and Dexmedetomidine on Prevention of Cognitive Dysfunction after Cataract Surgery in the Elderly Patients under General Anesthesia Compared with the Control Group. J Isfahan Med Sch 2019; 36(504): 1395-400.
[21] Rajaei M, Tabari M, Soltani G, Alizadeh K, Nazari A, Noroozian M, Morovatdar N. Comparison between the Effects of Dexmedetomidine and Midazolam on Postoperative Cognitive Impairment after Coronary Artery Bypasses Graft Surgery: A Randomized Clinical Trial. J Tehran Heart Cent. 2019; 14(2):67-73.
[22] Cheung CW, Ying CL, Chiu WK, Wong GT, Ng KF, Irwin MG. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia. 2007; 62(11):1132-8.
[23] Mansouri N, Nasrollahi K, Shetabi H. Prevention of Cognitive Dysfunction after Cataract Surgery with Intravenous Administration of Midazolam and Dexmedetomidine in Elderly Patients Undergoing Cataract Surgery. Adv Biomed Res. 2019; 8(1):6.
| Files | ||
| Issue | Vol 6 No 4 (2020): Autumn |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v6i4.4629 | |
| Keywords | ||
| Dexmedetomidine Orthopedics Postoperative Cognitive Dysfunction | ||
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How to Cite
1.
Pournajafian A, Khatibi A, Ghodraty MR, Emami A, Haji Aghajani M. Effect of Preoperative Dexmedetomidine on Prevalence of Postoperative Cognitive Dysfunction in Elderly Patients Candidate for Orthopedic Surgery under General Anesthesia. Arch Anesth & Crit Care. 2020;6(4):182-187.
