Role of Dexmedetomidine in Early POCD in Patients Undergoing Thoracic Surgery.

Jiao Ran,Xuehan Li,Xiao Bai,Rurong Wang,Mian Peng

doi:10.1155/2021/8652028

Abstract

Objective To evaluate whether a low-dose perioperative infusion of Dex reduces early POCD. Design This study was a double-blind, randomized, placebo-controlled trial that randomly assigned patients to Dex or saline placebo infused during surgery and patient-controlled intravenous analgesia (PCIA) infusion. Patients were assessed for postoperative cognitive decline. Interventions. Dex was infused at a loading dose of 0.5 μg/kg intravenously (15 min after entering the operation room) followed by a continuous infusion at a rate of 0.5 μg/kg/h until one-lung ventilation or artificial pneumothorax ended. Patients in the Dex group received regular PCIA pump with additional dose of Dex (200 μg). Results In total, 126 patients were randomized, and 102 patients were involved in the result analysis. The incidence of POCD was 36.54% (19/52) in the Dex group and 32.00% (16/50) in the normal saline (NS) group, with no statistic difference. No significant difference was observed between the two groups in terms of Telephone Interview for Cognitive Status-Modified (TICS-m) scores at different times. However, the TICS-m score at 7 days after surgery was significantly lower than that at 30 days in 102 patients (32.93 ± 0.42 vs. 33.92 ± 0.47, P = 0.03). The visual analogue scale scores in the Dex group were significantly lower than those in the NS group 1 day postoperation at rest and activity (2.00 [1.00–3.00] vs. 3.00 [2.00–4.00], P < 0.01; 4.00 [3.00–5.00] vs. 5.00 [4.00–6.00], P < 0.05, respectively). Patients receiving Dex or NS had no statistical difference in activities of daily living (ADLs) scores at 7 and 30 days after surgery, but the ADL score at 30 days after surgery showed a significant reduction compared with that at 7 days (P < 0.01). Patients in the Dex group had a shorter hospital length of stay (15.26 ± 3.77 vs. 17.69 ± 5.09, P = 0.02) and less expenses (52458.71 ± 10649.30 vs. 57269.03 ± 9269.98, P = 0.04) than those in the NS group. Conclusions Low-dose Dex in the perioperative period did not reduce the incidence of early POCD in thoracic surgery. However, it relieved postoperative pain, decreased the hospitalization expenses, and shortened the length of stay.

Highlights

Since the emergence of neuropsychological tests to objectively assess cognitive changes after cardiac surgery in the 1980s, postoperative neurocognitive disorder associated with anesthesia and surgery has become the concern of anesthesiologists [1]
Considering that Dex has a dose-dependent effect on postoperative cognitive dysfunction (POCD), we hypothesized that Dex administration during operation and patient-controlled intravenous analgesia (PCIA) with Dex could reduce the incidence of POCD in patients undergoing thoracic surgery
All patients were evaluated by the neuropsychological test battery (NTB; i.e., RBANS) [16] before surgery and 7 days after surgery/before discharge by a trained interviewer blinded to the treatment group

Summary

Introduction

Since the emergence of neuropsychological tests to objectively assess cognitive changes after cardiac surgery in the 1980s, postoperative neurocognitive disorder associated with anesthesia and surgery has become the concern of anesthesiologists [1]. The incidence of postoperative cognitive dysfunction (POCD) ranges from 6% to 53% [2, 3], varying with age, education level, comorbidity, and surgery. The underlying pathogenesis of POCD is the neuroinflammation and oxidative stress from anesthesia and surgery [6, 7]. On the basis of the neuroinflammatory hypothesis involved in POCD, anti-inflammatory and antioxidative stress strategies are potential treatments for patients undergoing thoracic surgery [6]. In animal and human studies, Dex can inhibit the release of proinflammatory cytokines [7]. Considering that Dex has a dose-dependent effect on POCD, we hypothesized that Dex administration during operation and patient-controlled intravenous analgesia (PCIA) with Dex could reduce the incidence of POCD in patients undergoing thoracic surgery

Methods

Results

Discussion

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Conflicts of Interest