The Influence of Different Dexmedetomidine Doses on Cognitive Function at Early Period of Patients Undergoing Laparoscopic Extensive Total Hysterectomy

Abstract

Background. This study aims to analyze the influence of different dexmedetomidine doses on cognitive function. It works on early periods of patients undergoing laparoscopic extensive total hysterectomy. Method. 119 patients with gynecological cancer underwent a laparoscopic extensive total hysterectomy. The operation was performed at the Affiliated Women’s and Children’s Hospital of Xiamen University from January 2019 to June 2020. The score of MoCA and the level of TNF-α, IL-6, S-100β protein, NSE, and GFAP of each group were compared 1 day before and after operation and 3 and 7 days after operation. Result. In four groups, remifentanil, sufentanil, and propofol were given in the following order: group A > group D > group C > group B. Group A > group D > group C in terms of time spent in the recovery room, extubation, and recovery from anesthesia. The difference between groups B and C was not significant ( P > 0.05 ). Compared with group A, group B scored higher in MoCA at 1 day (T1), 3 days (T2), and 7 days (T3) after operation ( P < 0.05 ). At the same scoring point, the score was group B > group C > group D > group A. The POCD of four groups all occurred at 3 days after surgery. Compared with the T0 point, the level of TNF-α and IL-6 of the four groups at T1 and T2 was significantly increased ( P < 0.05 ). At T3, the level of TNF-α and IL-6 gradually decreased. At various periods, the levels of S-100 protein, NSE, and GFAP in groups B, C, and D were lower than those in group A (P0.05). Group B had a substantially higher rate of bradycardia than the other three groups (P0.05). The incidence of chills, respiratory depression, and restlessness in group A differed significantly from the other three groups ( P < 0.05 ). Conclusion. Using 0.5 μg/kg dexmedetomidine during the perianaesthesia can effectively reduce anesthetic drugs in patients. They had a laparoscopic extensive complete hysterectomy, which helps to reduce the adverse responses and the occurrence of POCD while also protecting brain function.

Effect of Dexmedetomidine on Recovery from Anesthesia in Gynecologic Laparoscopic Surgery

“…In addition, this procedure allows for fine observation of the lesion under laparoscopic guidance, which contributes to avoiding traumatic areas during the surgery, thus reducing the risk of disease recurrence [10] . Moreover, this procedure obviate the need to open the patient's abdomen, which effectively reduces intraoperative bleeding and the use of postoperative pain medication, thereby significantly improving the safety of the surgery [11] . However, special positions and the construction of a pneumoperitoneum are currently necessary for laparoscopic surgery, resulting in stimulation of the respiratory and cardiovascular systems and triggering a series of stress reactions [12] .…”

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

“…In another study, dexmedetomidine was intravenously injected 10 min before anesthesia induction to 119 patients with gynecologic cancer who had undergone laparoscopic extensive hysterectomy, with a load of 1, 0.5, and 0.25µg/kg at a rate of 0.2 µg/(kg•h) until 30 minutes before the end of the operation. 0.5 µg/kg dexmedetomidine during the perianesthetic period could effectively reduce the occurrence of adverse reactions and POCD and protect brain function (Huang et al, 2021). An increasing body of evidence from recently published meta-analyses suggests that, compared with other drugs (such as sevoflurane, propofol and benzodiazepines), dexmedetomidine can improve short-term and long-term cognitive function, especially in cardiac surgery (Li M. et al, 2020;Burry et al, 2021;Xiong et al, 2021;Yu et al, 2022).…”

Study on the Effect of Dexmedetomidine on Postoperative Cognitive Dysfunction and Inflammation in Aged Rats

“…Some studies suggested that dexmedetomidine decreased the behavior of patients with postoperative cognitive dysfunction via protecting the function of nerve cells [7]. Other studies reported that dexmedetomidine did not affect the postoperative cognition in over 70-year old patients receiving elective operations [8].…”

“…Some studies suggested that dexmedetomidine decreased the behavior of patients with postoperative cognitive dysfunction via protecting the function of nerve cells [ 7 ]. Other studies reported that dexmedetomidine did not affect the postoperative cognition in over 70-year old patients receiving elective operations [ 8 ]. Thus, further studies are required for evaluating the effects of dexmedetomidine on postoperative cognitive dysfunction and investigate the involved mechanisms [ 9 ].…”