Abstract
BackgroundPostoperative cognitive dysfunction (POCD) is one of the most common. Neuroprotective effects of dexmedetomidine (DEX) are reported in previous studies but evidence regarding the POCD is still unclear. In order to gain latest evidence, the present study analyzes the outcomes of randomized controlled trials (RCTs) which utilized DEX with general anaesthesia perioperatively.MethodFour online databases (PubMed, Embase, the Cochrane Library, and CNKI) were used to find relevant RCTs to conduct systematic analysis. All studies comparing the incidence of POCD or MMSE score between the DEX group and the placebo or comparator group in patients undergoing general anaesthetic surgery were eligible for inclusion. Based on the inclusion and exclusion criteria, the studies were selected. This meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference (SMD) and 95% CIs for continuous data as effective measures.ResultsIn total of 21 studies were included in this meta-analysis. The results showed that the incidence of POCD in DEX group was significantly lower than the control group on the first (OR = 0.36, 95% CI 0.24–0.54),third (OR = 0.45,95% CI 0.33–0.61) and seventh (OR = 0.40,95% CI 0.26–0.60) postoperative days; the MMSE scores in DEX group were higher than the control group on the first (SMD = 1.24, 95% CI 1.08–1.41), third(SMD = 1.09, 95%CI 0.94–1.24) and seventh (SMD = 3.28, 95% CI 1.51–5.04) postoperative days.ConclusionsIntraoperative DEX use can ameliorate the POCD of patients who received surgical operations under general anesthesia, and effectively reduce the incidence of POCD and improve MMSE score.
Highlights
Postoperative cognitive dysfunction (POCD) is one of the most common complications affecting the central nervous system after general anaesthesia and surgery, especially in elderly patients, which is characterizedLi et al Journal of Cardiothoracic Surgery (2021) 16:351 independent living, and increased mortality [6,7,8]
The results showed that the incidence of POCD in DEX group was significantly lower than the control group on the first (OR = 0.36, 95% confidence intervals (CIs) 0.24–0.54),third (OR = 0.45,95% CI 0.33–0.61) and seventh (OR = 0.40,95% CI 0.26–0.60) postoperative days; the Mini Mental State Examination (MMSE) scores in DEX group were higher than the control group on the first (SMD = 1.24, 95% CI 1.08–1.41), third(SMD = 1.09, 95%CI 0.94–1.24) and seventh (SMD = 3.28, 95% CI 1.51–5.04) postoperative days
Inclusion and exclusion criteria Studies were included according to the following criteria: (1) all of the enrolled studies were randomized controlled trials (RCTs); (2) adult patients undergoing surgery under general anaesthesia; (3) the experimental group received a single or continuously-administered intravenous dose of intraoperative DEX; the control groups received an intravenous injection of placebo or comparator; (4) the main outcomes in enrolled studies were the incidence of POCD, postoperative MMSE score; (5) all of included studies contained original data sufficient for meta-analysis
Summary
Postoperative cognitive dysfunction (POCD) is one of the most common complications affecting the central nervous system after general anaesthesia and surgery, especially in elderly patients, which is characterizedLi et al Journal of Cardiothoracic Surgery (2021) 16:351 independent living, and increased mortality [6,7,8]. Postoperative cognitive dysfunction (POCD) is one of the most common complications affecting the central nervous system after general anaesthesia and surgery, especially in elderly patients, which is characterized. A previous study has suggested that DEX is efficient in the treatment of nerve diseases through the beneficial effects of decreasing central nervous system sympathetic outflow and providing sedation and analgesia [19]. Some clinical studies have indicated that DEX has analgesic, anxiolytic and anti-delirium effects without respiratory depression [17, 21]. These properties make it anappropriate option for sedation in the intensive care unit and in perioperative period. Postoperative cognitive dysfunction (POCD) is one of the most common. In order to gain latest evidence, the present study analyzes the outcomes of randomized controlled trials (RCTs) which utilized DEX with general anaesthesia perioperatively
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