The effect of Dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery

Mohamed, Sahar Abdel-Baky; Shaaban, Ahmad Ramzy

doi:10.1016/j.egja.2014.03.007

Cited by 15 publications

(36 citation statements)

References 26 publications

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“…On the other hand, Mohamed and Shaaban reported that using dexmedetomidine was not associated with protection against POCD in elderly patients after major surgery (31), another study also reported that dexmedetomidine has no neuroprotective effect after cardiac surgery, and both attributed their results to small sample size, long duration of surgery and type of patient (32). When using esmolol and dexmedetomidine to reach the target MAP (55 -65 mmHg), it was not required to increase the sevoflurane concentration, and this was the benefit of using these adjuvants during controlled hypotension since increasing the dose of inhalational anesthetics to produce controlled hypotensive anesthesia affects the brain function, including the cerebral blood flow and metabolism.…”

Section: Discussionmentioning

confidence: 98%

The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study

2020

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Objectives: Postoperative cognitive dysfunction (POCD) is multifactorial, which may be caused by anesthetic and surgical causes or cerebral injury. This study aimed to evaluate the effect of dexmedetomidine as a neuroprotective drug compared to esmolol on the prevalence of POCD in adult patients undergoing middle ear surgeries under hypotensive anesthesia. Methods: This study included male and female adult patients, according to American Society of Anesthesiology physical status (ASA) I, the patients who underwent middle ear surgeries under hypotensive anesthesia were randomly assigned to two groups that received esmolol and dexmedetomidine. The demographic data, heart rate, mean arterial blood pressure, duration of the surgery, evaluation of the surgical field, and the Mini-Mental State Examination (MMSE) (preoperatively and at 1, 6 and 24 hours postoperatively) were recorded. Results: There was a significant difference between the numbers of patients who had POCD in MMSE1: 12 cases in the esmolol group (41.37%) compared to three cases in the dexmedetomidine group (10.34%) (P = 0.016), in MMSE6: 10 cases in the esmolol group (34.48%) compared with two cases in the dexmedetomidine group (6.89%) (P = 0.023) and in MMSE24: seven cases in the esmolol group (24.13%) compared with one case in the dexmedetomidine group (3.44%) (P = 0.022), while the median and range of MMSE score were comparable between the two groups (P > 0.05). Conclusions: This study suggests that intraoperative use of dexmedetomidine as an adjuvant to hypotensive anesthesia reduces the incidence of POCD compared to esmolol.

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Section: Discussionmentioning

confidence: 98%

The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study

2020

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“…Seven trials were included in meta-analysis of the primary outcome (Table 1). [57][58][59][60][61][62][63] Two of 11 studies were not included in meta-analysis of the primary outcome, but for the secondary outcome of delirium. 64,65 Two of 11 studies were not included in analysis of the primary outcome but were for the secondary outcome of hemodynamic instability.…”

Section: Resultsmentioning

confidence: 99%

“…Among 11 studies in the qualitative synthesis, 8 concluded DEX improved cognitive outcomes. 58,[60][61][62][63][65][66][67] Two trials did not demonstrate significant differences between groups, 57,64 and 1 concluded DEX was inferior. 59 Seven reported dichotomous outcomes for the proportion of participants developing dNCR, and these were included in the meta-analysis.…”

Section: Delayed Neurocognitive Recoverymentioning

confidence: 99%

The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Noncardiac Surgery

Singh

Broad

Brenna

et al. 2022

Annals of Surgery Open

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Objective: The purpose of this review is to examine the effect of dexmedetomidine on delayed neurocognitive recovery (dNCR; cognitive dysfunction ≥1 week postoperative) after major noncardiac surgery. Background: Dexmedetomidine (DEX) effectively reduces delirium in the intensive care unit and reportedly attenuates cognitive decline following major noncardiac surgery. Ascertaining the true effect on postoperative cognition is difficult because studies are limited by suboptimal selection of cognitive assessment tools, timing of testing, and criteria for defining significant cognitive decline Methods: Prospective randomized trials comparing perioperative DEX to placebo for major noncardiac surgery assessing cognitive function ≥1 week postoperative were included. Pediatric, nonhuman, and non-English trials, and those where executive function was not assessed were excluded. Data were abstracted by 3 reviewers independently and in parallel according to PRISMA guidelines. The a priori binary primary outcome is dNCR defined as cognitive function declining by the minimal clinically important difference or accepted alternate measure (eg, Reliable Change Index ≥1.96). Bias was assessed with the Cochrane Collaboration tool. Data were pooled using a random effects model. Results: Among 287 citations identified, 26 (9%) met criteria for full-text retrieval. Eleven randomized trials (1233 participants) were included for qualitative analysis, and 7 trials (616 participants) were included for meta-analysis of dNCR. Dexmedetomidine did not reduce the incidence of dNCR significantly (OR 0.57, 95% CI 0.30–1.10, P = 0.09) compared with placebo. There was no difference in the incidence of delirium (OR 0.94, 95% CI 0.55–1.63, P = 0.83) and a higher incidence of hemodynamic instability (OR 2.11, 95% CI 1.22–3.65, P = 0.008). Conclusions: Dexmedetomidine does not reduce dNCR 1 week after major noncardiac surgery. This meta-analysis does not yet support the use of perioperative DEX to improve short term cognitive outcomes at this time; trials underway may yet change this conclusion while larger trials are needed to refine the point estimate of effect and examine long-term cognitive outcomes.

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“…Twenty six studies were selected for the final analysis after these exclusions. [13–38] A flowchart of the study screening and selection process was given in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Effect of dexmedetomidine on postoperative cognitive dysfunction and inflammation in patients after general anaesthesia

et al. 2019

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The effect of Dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery

Cited by 15 publications

References 26 publications

The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study

The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study

The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Noncardiac Surgery

Effect of dexmedetomidine on postoperative cognitive dysfunction and inflammation in patients after general anaesthesia

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