The Effect and Optimal Dosage of Dexmedetomidine Plus Sufentanil for Postoperative Analgesia in Elderly Patients With Postoperative Delirium and Early Postoperative Cognitive Dysfunction: A Single-Center, Prospective, Randomized, Double-Blind, Controlled Trial.

Wenshuai Zhao,Xifan Wang,Yanan Hu,Xiaohong Wu,Fei Han,Liping Wang,Hui Chen,Yu Wang

doi:10.3389/fnins.2020.549516

Abstract

BackgroundPostoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications after major surgery among elderly patients. Dexmedetomidine (DEX) is less frequently explored for its effects in patients with postoperative neurocognitive disorders. This study investigated the effect and optimal dosage of DEX for patient-controlled analgesia (PCA) on POD and early POCD after major surgery among elderly patients.MethodsPatients in four groups received continuous infusion of DEX 0, 100, 200, and 400 μg with sufentanil 150 μg for PCA immediately after surgery. POD and POCD were assessed on postoperative days 1, 2, 3, and 7 by using the Confusion Assessment Method (CAM) and Mini-Mental State Examination (MMSE) scales. Furthermore, the incidence of POD and POCD of all the four groups in postoperative 7 days classified by high risk factors (age, education, surgical site, and surgical category), sedation level, postoperative pain intensity, and side effects were assessed.ResultsThe overall incidence rates of POD and early POCD 7 days after surgery were lower in the DEX 200 μg 400 μg groups than in the DEX 0 μg and 100 μg groups (P < 0.05). Compared with DEX 200 μg, DEX 400 μg reduced early POCD in patients who underwent open surgery (P < 0.05). There were no intergroup differences in the postoperative sedation level, pain intensity, and side effects.ConclusionThe continuous infusion of DEX 200 μg or DEX 400 μg in PCA significantly decreased the incidence of POD and early POCD after major surgery without increasing any side effects. Compared with DEX 200 μg, DEX 400 μg was preferred for reducing early POCD in patients who underwent open surgery.

Highlights

METHODSPerioperative neurocognitive disorders, recognized in one form or another for more than 100 years, affect patients, elderly patients, after anesthesia and surgery (Evered et al, 2018a,b)
Delirium is associated with an increased incidence of early postoperative cognitive dysfunction (POCD), which is reported to occur in 20–50% of patients in the first postoperative week and in 10% of patients 3 months after surgery (Rasmussen, 2006; Rudolph et al, 2008)
Dexmedetomidine (DEX) is a highly selective α2 adrenoreceptor agonist that preserves neurologic function and attenuates neuronal injury (Bell et al, 2014). It exerts a protective effect against cognitive disabilities by inhibiting the hippocampal inflammatory response and neuronal apoptosis induced by surgical trauma (Bekker et al, 2013; Qian et al, 2015)

Summary

Introduction

METHODSPerioperative neurocognitive disorders, recognized in one form or another for more than 100 years, affect patients, elderly patients, after anesthesia and surgery (Evered et al, 2018a,b). Dexmedetomidine (DEX) is a highly selective α2 adrenoreceptor agonist that preserves neurologic function and attenuates neuronal injury (Bell et al, 2014). It exerts a protective effect against cognitive disabilities by inhibiting the hippocampal inflammatory response and neuronal apoptosis induced by surgical trauma (Bekker et al, 2013; Qian et al, 2015). This study was designed with an aim to investigate the effects and optimal dosage of DEX for PCA to prevent POD and early POCD after major surgery in elderly patients. This study investigated the effect and optimal dosage of DEX for patient-controlled analgesia (PCA) on POD and early POCD after major surgery among elderly patients

Methods

Results

Conclusion