The effect of intraoperative dexmedetomidine on cognitive dysfunction after surgery: a updated meta-analysis

Abstract

Background Postoperative cognitive dysfunction (POCD) is one of the most common. Neuroprotective effects of dexmedetomidine (DEX) are reported in previous studies but evidence regarding the POCD is still unclear. In order to gain latest evidence, the present study analyzes the outcomes of randomized controlled trials (RCTs) which utilized DEX with general anaesthesia perioperatively. Method Four online databases (PubMed, Embase, the Cochrane Library, and CNKI) were used to find relevant RCTs to conduct systematic analysis. All studies comparing the incidence of POCD or MMSE score between the DEX group and the placebo or comparator group in patients undergoing general anaesthetic surgery were eligible for inclusion. Based on the inclusion and exclusion criteria, the studies were selected. This meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference (SMD) and 95% CIs for continuous data as effective measures. Results In total of 21 studies were included in this meta-analysis. The results showed that the incidence of POCD in DEX group was significantly lower than the control group on the first (OR = 0.36, 95% CI 0.24–0.54),third (OR = 0.45,95% CI 0.33–0.61) and seventh (OR = 0.40,95% CI 0.26–0.60) postoperative days; the MMSE scores in DEX group were higher than the control group on the first (SMD = 1.24, 95% CI 1.08–1.41), third(SMD = 1.09, 95%CI 0.94–1.24) and seventh (SMD = 3.28, 95% CI 1.51–5.04) postoperative days. Conclusions Intraoperative DEX use can ameliorate the POCD of patients who received surgical operations under general anesthesia, and effectively reduce the incidence of POCD and improve MMSE score.

Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis

“…Third, as for the limitations of the included studies or the review process itself, our included studies have heterogeneities such as different cognitive evaluation tools (Lili et al, 2013;Xu et al, 2017;Zhang et al, 2019;Zhu et al, 2016). Different neurocognitive evaluation tools may have different cognitive evaluation results (Li et al, 2021a;Yu et al, 2022).…”

“…Since the incidence of POCD was signif-icantly different between cardiac surgery and noncardiac surgery, we only evaluated the prevention and treatment effects of these drugs on POCD in noncardiac surgery (Brodier & Cibelli, 2021;Czok et al, 2021). We found that neurocognitive tests are often performed on postoperative days 1, 3, and 7, according to the present RCTs (Duan et al, 2021;Huang et al, 2020a;Li et al, 2021a;Mansouri et al, 2019).…”

“…In view of the different incidence rates of POCD at different time points after operation, we performed summary statistics and metaanalyses on the occurrence of POCD on postoperative days 1, 3, and 7 (Duan et al, 2021;Huang et al, 2020a;Li et al, 2021a;Mansouri et al, 2019).…”

A Survey on Enhanced Recovery After Surgery (ERAS) Elements in Cleft Palate Repair

“…The most common perioperative complication of primary cleft palate repair is respiratory in nature, 16 representing a potentially useful context for DEX utilization. DEX has been shown to ameliorate postoperative cognitive dysfunction 17 and be more effective 1308…”

“…The most common perioperative complication of primary cleft palate repair is respiratory in nature, 16 representing a potentially useful context for DEX utilization. DEX has been shown to ameliorate postoperative cognitive dysfunction 17 and be more effective than propofol in treating emergence delirium in the postanesthetic stage of pediatric patients. 18 It has also been associated with lower pain scores, decreased opiate use, and shorter hospital LOS in children who underwent decompression of a Chiari malformation.…”