Effects of dexamethasone on post-operative cognitive dysfunction and delirium in adults following general anaesthesia: a meta-analysis of randomised controlled trials

Abstract

Background Several studies have investigated the effects of dexamethasone on post-operative cognitive dysfunction (POCD) or post-operative delirium (POD); however, their conclusions have been inconsistent. Thus, we conducted a meta-analysis to determine the effects of dexamethasone on POCD and POD in adults following general anaesthesia. Methods The Cochrane Central Register of Controlled Trials (2018, Issue 11 of 12) in the Cochrane Library (searched 17 November 2018), MEDLINE OvidSP (1946 to 16 November 2018) and Embase OvidSP (1974 to 16 November 2018) were searched for randomised controlled trials that evaluated the incidence of POCD and POD following dexamethasone administration in adults (age ≥ 18 years) under general anaesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations framework to assess the quality of the evidence. Results Five studies were included (three studies with 855 participants in the dexamethasone group and 538 participants in the placebo group for the incidence of POCD, and two studies with 410 participants in the dexamethasone group and 420 participants in the placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD 30 days after surgery (RR [relative risk] 1.00; 95% CI [confidence interval: 0.51, 1.96], P = 1.00, I 2 = 77%) or the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I 2 = 0%). However, both analyses had some limitations because of limited evidence and clinical heterogeneity, and we considered the quality of the evidence for the post-operative incidence of POCD and POD to be very low. Conclusions This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative preventive strategies for POCD and POD, as well as a better understanding of the pathophysiology of those complex syndromes, are still needed to make progress in this field. Trial registrationr This study is registered with PROSPERO, 23 October 2018, number CRD42018114552. Available from https://www.crd.york.ac.uk/PROSPERO/#recordDetails . Electronic supplementary material The online version of this article (10.1186/s12871-019-0783-x) contains supplementary material, which is available to authorized users.

Association Between Dexamethasone and Delirium in Critically Ill Patients: A Retrospective Cohort Study of a Large Clinical Database

“…However, there are a large number of studies demonstrating that the occurrence of POD in patients using DEX is not signi cantly different from that in patients not using it [14,20,31,32]. The occurrence of POD is the result of the interaction of multiple factors, and a single intervention cannot completely affect it.…”

“…The occurrence of POD is the result of the interaction of multiple factors, and a single intervention cannot completely affect it. Although there is evidence that in ammation is an important pathogenesis of POD, other factors that have not been clari ed may play a greater role in the occurrence and development of POD [14,33], such as surgical factors, anesthetic drugs, especially benzodiazepines, which have been shown to seriously affect and exacerbate the occurrence of POD [31,34,35], and these factors are not present in most non-surgical critically ill ICU patients. It also explains why treatment with other antiin ammatory drugs such as statins [36] and haloperidol [37,38] does not appear to reduce the incidence of POD.…”

“…There is increasing evidence that the response of the brain to peripheral in ammation may play a role in the development of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) [13,14]. Dexamethasone (DEX) is a long-acting glucocorticoid widely used in various in ammatory diseases [15].…”

“…Dexamethasone (DEX) is a long-acting glucocorticoid widely used in various in ammatory diseases [15]. If the in ammatory reaction plays a role in the development of POD and POCD, then inhibiting the in ammatory response by DEX may prevent the development of POD and POCD [14,16]. However, other reports have demonstrated that high-dose oral glucocorticoid therapy increases the risk of psychiatric events, such as mood disorders, anxiety, aggressive behavior, insomnia, irritability, depersonalization, panic disorder, suicidal thoughts, dementia, and delirium [17,18].…”

Pediatric dentist accessibility and post-operative complications of laryngeal mask airway versus nasotracheal intubation in full mouth rehabilitation under general anaesthesia: a randomised controlled trial

“…In full mouth rehabilitation, general anaesthesia decreases the psychological and physical stress for all parties included namely the child, the parents and the pediatric dentist. However, there are some undesirable effects of GA, including transient incidents of postoperative nausea and vomiting (PONV), dizziness, headache, and agitation; or more severe complications as respiratory depression, respiratory arrest, laryngospasm, and anaphylaxis [9,10] .…”