ObjectivePostoperative delirium (POD) is a serious complication in elderly patients undergoing cardiac surgery. This study was aimed at investigating the effect of perioperative administration of dexmedetomidine for general anesthesia maintenance on occurrence and duration of POD in elderly patients after cardiac surgery.MethodsOne hundred and sixty-four patients were enrolled after cardiac surgery between June 2009 and December 2016. Patients were assigned by a computer-generated randomization sequence in a 1:1 ratio to receive dexmedetomidine general anesthesia maintenance or propofol general anesthesia maintenance. POD was assessed every day with confusion assessment method for intensive care units (ICU) during the first 5 postoperative days.ResultsThere was no significance in incidence of POD between the dexmedetomidine group and the propofol group (P=0.0758). In patients treated with dexmedetomidine, the median onset time of delirium was delayed (second day vs first day) and the duration of delirium reduced (2 days vs 3 days) when compared with propofol-treated patients. The dexmedetomidine-treated patients also displayed a lower VAS score and less opiate analgesic consumption. No difference was observed in respect to other postoperative outcomes.ConclusionFor elderly patients, perioperative administration of dexmedetomidine reduced incidence, delayed onset and shortened duration of POD after cardiac surgery.

Addition of dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine provided adequate anesthesia and postoperative analgesia compared to fentanyl adjuvant without causing any significant side effects.

At the request of the authors, the Editor and Publisher of Clinical Interventions in Aging wish to retract the published article. Following publication, concerns were raised that the reported study did not match with details of the associated study that had been registered in the Chinese Clinical Trial Registry under registration number, ChiCTR-IOR-17014122.The authors responded to our queries and explained that they failed to complete registration of the study to the Chinese Clinical Trial Registry before starting their clinical research. Their request to retrospectively register the study prior to publication was declined by the Chinese Clinical Trial Registry because the trial had already been completed for three years. To comply with journal requirements the authors provided the clinical registration number (ChiCTR-IOR -17014122) from an unrelated dexmedetomidine study by members of their own research group. The owners of the study associated with registration number, ChiCTR-IOR-17014122, were unaware this number had been used in the publication of another study.The authors contacted the journal to request that the article be retracted and put this error in judgement down to inexperience and wish to apologise for any confusion that was caused.Our decision-making was informed by our policy on publishing ethics and integrity and the COPE guidelines on retraction.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as "Retracted".

The present study aimed to investigate the effects of sevoflurane post-conditioning in a rat brain cerebral ischemia-reperfusion (I/R) model and examine its possible mechanism. Rats were randomly divided into six groups: Sham control group (Sham), I/R group, sevoflurane group (Se), Toll-like receptor-4 (TLR4) inhibitor group (Tak-242), nuclear factor (NF)-κB inhibitor group (QNZ) and Sevoflurane post-conditioning combined with TLR4-NF-κB signaling pathway inhibitor group (Se + Tak-242). Morris water maze test and tetrazolium chloride staining were used to investigate the I/R injury. The nerve cell apoptosis and autophagy in cortical tissue were detected by TUNEL and transmission electron microscopy, respectively. The expression of TLR4 protein in cortical tissue was observed by immunohistochemical staining. The expression of autophagy and apoptotic associated proteins in cortical tissues and the activity of TLR4-NF-κB signaling pathway were assayed by western blot analysis. Sevoflurane post-conditioning improved the learning and memory dysfunction caused by cerebral I/R injury. The cerebral infarction area, nerve cell apoptosis and formation of autophagic vacuoles were reduced after sevoflurane administration. The expression of light chain 3II/I, Beclin-1, Bad and Cleaved-Caspase-3 proteins were inhibited and the expression of Bcl-2 protein was upregulated after sevoflurane administration. Sevoflurane post-conditioning also inhibited the TLR4 protein and NF-κB phosphorylation, and increased inhibitor of kBα phosphorylation. The treatment effect of Tak-242 and QNZ groups were not significantly different compared with the Se group (P>0.05), and the Se + Tak-242 group had the best results. The present study demonstrated that sevoflurane post-conditioning could protect middle cerebral artery occlusion-induced brain injury rats by inhibiting autophagy and apoptosis, and that its mechanism is related to the TLR4-NF-κB signaling pathway.