Intraoperative dexmedetomidine infusion might preserve cognitive functions of elderly patients undergoing spinal surgeries under general anesthesia

Abstract

Abstract Background Elderly patients are more vulnerable to anesthesia-related cognitive dysfunction. Spinal surgery consumes long theater time that may affect patients’ outcome especially the elderly ones. Anesthetic manipulations were supposed to modulate cognitive outcomes of patients. Aims Evaluation of the effect of intraoperative (IO) dexmedetomidine (DEX) infusion during spinal surgery on the incidence and severity of postoperative cognitive disorders (POCD). Patients and methods 152 patients were divided into Group P received a placebo infusion and Group D DEX infusion (0.5 µg/kg/h) with induction of anesthesia until wound closure. Cognitive function (CF) was assessed using Mini-Mental State Examination (MMSE) pre- and postoperatively. The median value of CF deficit in 4-week PO was calculated, and its correlation to the type of IO infusions and patients’ data were evaluated. The effect of DEX infusion on the incidence and severity of POCD is the study outcome. Results DEX infusion significantly decreased the incidence and severity of POCD with a significantly lower deficit in the MMSE score of patients of group D. The MMES deficit was positively correlated to age, body mass index (BMI), presence of systemic diseases, and infusion type. The use of DEX, young age, and low BMI are significant predictors for normal CF. Conclusion DEX infusion for elderly patients undergoing major surgeries of long operative time and predicted blood loss significantly reduced the incidence and severity of POCD. The used dose of DEX was appropriate for preserving CF without hemodynamic effects.