Dexmedetomidine (DEX) was widely used in clinical work. However, the effectiveness of DEX on postoperative cognitive dysfunction (POCD) was still need to be confirmed. The aim of this meta-analysis was to explore whether DEX can reduce the incidence of POCD on the first day and seventh postoperative day. The results showed that lower incidence of POCD associated with DEX treatment on the first (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.31-0.54) or seventh postoperative day (OR: 0.53; 95% CI: 0.36-0.77). Mini-Mental State Examination scores on the first (mean difference [MD]: 4.67; 95% CI: 1.72-7.63) and seventh postoperative days (MD: 3.71; 95% CI: 2.51-4.90) were higher in DEX use group than that in physiological saline group. Meanwhile, neuron-specific enolase (NSE; MD: −3.99; 95% CI: −6.20 to −1.78) and interleukin 6 (IL-6) levels (MD: −17.53; 95% CI: −21.51 to −13.54) on the first postoperative day in DEX group were lower than that in the physiological saline group. This meta-analysis suggested that DEX use could reduce the risk of POCD and the reduction in levels of NSE and IL-6 can improve long-term cognitive dysfunction and anti-inflammation.
Postoperative cognitive dysfunction (POCD), also named as postoperative neurocognitive disorder (NCD) (Evered, Silbert, & Knopman, 2018), is a highly prevalent disorder, especially in elderly patients, characterized by acute or persistent deficits in attention, concentration, learning, and memory following surgery, which can be detected by a battery of neuropsychological tests (Skvarc, Berk, & Byrne, 2018). POCD can prolong hospital stay, reduce quality of life, increase mortality, and aggravate the burden of public health, leading
Background:
Ultrasound-guided proximal or distal approach for obturator nerve block is preformed to prevent adductor muscle spasm during transurethral resection of bladder tumors. The aim of the study was to compare the effectiveness of two different techniques in blocking the obturator nerve during transurethral resection of a bladder tumor.
Methods:
Fifty obturator nerve blocks were performed for transurethral bladder tumor resection and divided into two groups. One group received ultrasound-guided proximal obturator nerve block approach (proximal group), and the other group received ultrasound-guided distal obturator nerve block approach (distal group). Grade of adductor muscle spasm, the rate of clinical effectiveness, duration of block procedure, and complications were recorded. Patients with grade two adductor spasms were transferred to general anesthesia.
Results:
Two patients in the distal group and one in the proximal group were transferred to general anesthesia for severe adductor muscle spasms. No difference was found in clinical effectiveness rate of obturator nerve block between the two groups. differed insignificantly. The number of patients who had no adductor muscle spasms in the proximal group was significantly higher than that of the distal group. Vascular puncture was detected in two patients in the proximal group and one patient in the distil group. No other complications were observed.
Conclusion:
No difference was found for clinical effectiveness between the two groups. However, vascular puncture should receive more attention.
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