Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients

Abstract

Laparoscopic cholecystectomy is performed with increasing frequency in aging populations. However, in elderly patients, cognitive dysfunction following surgery may impair the outcome of surgical procedures. Dexmedetomidine (DEX) has been demonstrated to have a neuroprotectve effect in animal experiments. However, it is unclear whether DEX also has a neuroprotective effect in human patients. The present study was a randomized, placebo-controlled double-blind trial of 126 patients who had undergone laparoscopic cholecystectomy, using clinical interviews to determine whether intravenously administrated DEX during general anesthesia ameliorates cognitive function impairment. The cognitive deficit of each patient was assessed using the Mini-Mental State Examination (MMSE). The scores on the MMSE for the DEX and control groups one week after surgery (DEX group, 27.6±1.2; control group, 25.7±1.5) were significantly different (P=0.005). The MMSE scores of patients ≤65 years old were significantly higher than those of patients >65 one week after surgery. The MMSE scores were significantly different between the two age groups in the control patients (≤65 years old, 28.3±1.2; >65 years old, 26.6±2.1; P=0.036), while the difference was not statistically significant in the DEX-treated patients. Eight patients in the DEX group and 15 patients in the control group had mild cognitive impairment (26≥ MMSE score ≥21) although the difference was not statistically significant. The findings of the present study support the hypothesis that DEX administration may be an effective method for ameliorating postoperative cognitive impairment in elderly patients who have undergone laparoscopic cholecystectomy. Further research is required to confirm the findings of the present study.

Retracted: MicroRNA‐140‐5p elevates cerebral protection of dexmedetomidine against hypoxic–ischaemic brain damage via the Wnt/β‐catenin signalling pathway

“…The abnormal expression of miR‐140 has been reported to be induced after HIBD. DEX has been proven to regulate HIBD 8, 15. In an attempt to elucidate a potential HIBD therapeutic target, an investigation was pursued into miR‐140‐5p and its effects on cerebral protection of DEX against HIBD by targeting Wnt1 through the Wnt/β‐catenin signalling pathway in neonatal rats.…”

“…The Wnt/β‐catenin signalling pathway plays a central role in hypoxia–ischaemia (HI) as well as in other neurodegenerative disorders, thus revealing a potential target for the treatment of HIBD 14. Dexmedetomidine (DEX) has been reported to up‐regulate the blood pressure and heart rate, as well as down‐regulating HIBD 15. Therefore, the central aim of our study was to explore the effect of miR‐140‐5p by targeting Wnt1 through the Wnt/β‐catenin signalling pathway in relation to the cerebral protection role of DEX from HIBD in neonatal rats.…”

Beneficial effects of intravenous dexmedetomidine on cognitive function and cerebral injury following a carotid endarterectomy

“…A B C the present study, MMSE scores did not differ significantly between the two groups at T4 and T5; however, higher MMSE scores and a lower proportion of patients exhibiting a decline in MMSE scores were observed in group D at T2 and T3, as compared with group C. These results suggested that DEX may promote the recovery of cognition following CEA, which is consistent with theoretical results obtained previously (26). Previous studies have suggested that adrenergic receptors, in particular α2-ARs, may have an important role in promoting cognitive functions, including memory, learning and selective attention (12,27).…”

Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice

“…These reports suggest that dexmedetomidine play a beneficial role in POCD. Indeed, dexmedetomidine was shown to protect cognitive function after laparoscopic cholecystectomy and laparoscopic surgery for colorectal cancer in elderly patients (Chen et al, 2013;Zhang et al, 2014aZhang et al, , 2014b.…”