Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia

Abstract

BACKGROUND Dexmedetomidine is known to be a sedative. Recent studies suggest that administration of dexmedetomidine can prevent postoperative delirium (POD) which has been confirmed as a common complication after major surgery. However, its effects in patients undergoing oesophagectomy are scarce. OBJECTIVE To investigate the efficacy and safety of dexmedetomidine in reducing POD in elderly patients after transthoracic oesophagectomy with total intravenous anaesthesia (TIVA). DESIGN A randomised, double-blind, placebo-controlled trial. SETTING Single-centre, tertiary care hospital, November 2016 to September 2018. PATIENTS Eligible patients (n = 177) undergoing transthoracic oesophagectomy were randomly assigned to receive total intravenous anaesthesia (TIVA, n = 87) or dexmedetomidine with TIVA (DEX-TIVA, n = 90). INTERVENTIONS Patients receiving DEX-TIVA received a loading dose of dexmedetomidine (0.4 μg kg−1), over 15 min, followed by a continuous infusion at a rate of 0.1 μg kg−1 h−1 until 1 h before the end of surgery. Patients receiving TIVA received physiological saline with a similar infusion rate protocol. OUTCOME MEASURES The primary outcome was the incidence of POD. The secondary endpoints were the incidence of emergence agitation, serum interleukin-6 (IL-6) levels and haemodynamic profile. RESULTS All randomised patients were included with planned intention-to-treat analyses for POD. Delirium occurred in 15 (16.7%) of 90 cases given dexmedetomidine, and in 32 (36.8%) of 87 cases given saline (P = 0.0036). The DEX-TIVA group showed less frequent emergence agitation than the TIVA group (22.1 vs. 48.0%, P = 0.0058). The incremental change in surgery-induced IL-6 levels was greater in the TIVA group than DEX-TIVA group (P < 0.0001). CONCLUSION Adding peri-operative dexmedetomidine to a total intravenous anaesthetic safely reduces POD and emergence agitation in elderly patients undergoing open transthoracic oesophagectomy. These benefits were associated with a postoperative reduction in circulating levels of the pro-inflammatory cytokine IL-6 and stabilisation of the haemodynamic profile. TRIAL REGISTRATION Chinese Clinical Trials Register Identifier: ChiCTR-IPR-17010881.

Sleep Well and Recover Faster with Less Pain—A Narrative Review on Sleep in the Perioperative Period

“…Thus, it might have beneficial effects via this mechanism in reducing neuroinflammation. In support of this hypothesis, Hu et al [ 113 ] reported that the surgery-induced increase in IL-6 levels was lower in the patients receiving total intravenous anesthesia (TIVA) with dexmedetomidine compared with those having TIVA without dexmedetomidine.…”

“…It has been shown to prevent POD by reducing the requirement of opioids. Recently, it was also shown to prevent POD in the elderly who were anesthetized with total intravenous anesthesia [ 113 ]. In addition, low-dose (0.1 mg/kg/h) dexmedetomidine improved subjective sleep quality and increased total sleep time and stage N2 sleep in elderly patients in the postoperative ICU [ 114 ].…”

Effect of Dexmedetomidine on Intestinal Barrier in Patients Undergoing Gastrointestinal Surgery - A Single-Centre Randomized Clinical Trial

“…DEX is a new type of α2-adrenergic receptor agonist that can simultaneously act on the central and peripheral nervous systems, regulate autonomic nervous activity, and produce dose-dependent sedative, hypnotic and anti-anxiety effects. At the same time, DEX can reduce the incidence of delirium in patients , and it was widely used in the sedative treatment of critically ill patients [26,[32][33][34]. Our study found that, compared to MID, DEX had no signi cant effect on blood pressure at the depth of shallow sedation, At the same time, DEX can also shorten the length of ICU stay.…”

The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis

“…The overall risk of bias for our primary outcome was low for 10 (30%) studies, 42,45,46,51,58,62,63,66,67,72 and the rest were considered to have some concerns. All studies had satisfactory discussion or documentation regarding missing outcome data.…”