Prevention of Dexmedetomidine on Postoperative Delirium and Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Thoracoscopic Lobectomy

Abstract

Objective. To investigate the effect of dexmedetomidine on postoperative cognitive function and delirium in elderly patients undergoing thoracoscopic lobectomy. Methods. 109 elderly patients (age is more than 65 years) who underwent thoracoscopic lobectomy in our hospital from June 2020 to Feb 2022 were randomly divided into the dexmedetomidine (DEX) group (n = 54) and the control group (n = 55). The patients in the experimental group were given dexmedetomidine by intravenous pump, intravenous pump 0.5 μg/kg within 10 minutes, and maintained the speed of 0.5 μg/(kg. h) to 30 min before the operation was ended. The control group was given the same amount of normal saline. Delirium assessment-severity (CAM-S) assessment and Mini-Cog were used to assess the severity levels of POD and POCD 24 h before, 6 hours after, one day after the operation, three days after the operation, and 1 week after the operation. Serum TNF-αα and NSE levels were assessed by using enzyme-linked immunosorbent assay. NRS pain marks were assessed in the DEX group at postanesthesia care unit (PACU) and 24 postoperation. Surgical pierhysmographic index (SPI) evaluation was performed at five time points. Results. The Mini-Cog scores in the DEX group were markedly enhanced compared with those in the saline group 6 and 24 hours after the operation. The SPI values in the DEX group were markedly reduced within 2 min after intubation and at surgical sutures. Moreover, the CAM scores in the DEX group were markedly reduced 24 hours after the operation. Tumor necrosis factor-α (TNF-α) and neuron-specific enolase (NSE) levels were significantly decreased in the DEX group at T1∼T3. Conclusion. The use of dexmedetomidine in the thoracoscopic lobectomy in elderly patients could reduce the occurrence and severity of postoperative cognitive dysfunction and delirium.

Preoperative cognitive function as a risk factor of postoperative delirium in cancer surgeries: A systematic review and meta‐analysis

“…A total of 48 articles were included in this study (Table 1), of which 39 (81.25%) studies were cohort, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][39][40][41][42][45][46][47][49][50][51]54,57,[59][60][61][62][63][64][65][66][67][68] and 8 (16.6%) were randomized clinical 38,43,44,48,52,53,55,58 trials (one article excluded in the late stage as it was retracted in the publisher journal).…”

Recent advances in predicting, preventing, and managing postoperative delirium

“…Dexmedetomidine is the most promising pharmacologic agent in reducing the incidence of POD in the elderly, critically ill, and ventilated patients 22 , 49 , 50 . Two new prospective studies revealed that dexmedetomidine infusions were associated with a decreased incidence of POD in thoracoscopic lobectomy and coronary artery bypass procedures 21 , 51 . It is nevertheless premature to suggest that dexmedetomidine may reduce POD.…”

The Impact of Dexmedetomidine Doses on Postoperative Cognitive Dysfunction and Inflammatory Response in Elderly Female Patients Undergoing Laparoscopic Cholecystectomy

“…Various factors can trigger postoperative cognitive impairment in patients, such as age, low educational level, high-risk surgical types, postoperative complications, postoperative infections, and others; its occurrence may also be related to central nervous system in ammation, neurotransmitter abnormalities and others [3]. Researches have shown that dexmedetomidine (Dex) can effectively reduce the incidence of POCD after cardiac [4] and non-cardiac surgeries [5][6][7][8]. However, no studies has examined how different Dex doses affect POCD in elderly female patients after LC.…”