Role of dexmedetomidine in reducing the incidence of postoperative cognitive dysfunction caused by sevoflurane inhalation anesthesia in elderly patients with esophageal carcinoma.

Abstract

Sevoflurane anesthesia is a high-risk factor for postoperative cognitive dysfunction (POCD) in elderly patients. Recently, some studies demonstrated that dexmedetomidine (DEX) could reduce the incidence of POCD caused by sevoflurane anesthesia. We hypothesized that DEX could reduce the incidence of POCD caused by sevoflurane anesthesia through decreasing plasma interleukin (IL-6) and tumor necrosis factor (TNF)-α concentrations. A total of 120 patients aged 65-75 years scheduled for esophageal carcinoma resection were randomly assigned to four groups. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure patients' cognitive function the day before operation and the 1st, 3rd, and 7th postoperative days. The plasma TNF-α, IL-6, and S100 β protein concentrations were measured by ELISA 10 min before anesthesia administration and the 1st, 3rd, and 7th postoperative days. There were no significant differences in the demographic or clinical characteristics or perioperative hemodynamic status in all groups. Compared with Group M + P, the MMSE and MoCA scores were significantly lower and the plasma TNF-α, IL-6, and S100 β protein concentrations were significantly higher in Group M + S at the 1st, 3rd, and 7th postoperative days (P < 0.05). Compared with Group M + S, the MMSE and MoCA scores were significantly higher and the plasma TNF-α, IL-6, and S100 β protein concentrations were significantly lower in Group D + S at the 1st, 3rd, and 7th postoperative days (P < 0.05). The POCD incidence was higher in elderly patients receiving sevoflurane anesthesia and DEX could alleviate POCD in these patients through decreasing plasma TNF-α and IL-6 concentrations.