Perioperative neurocognitive disorder (PND) is a common complication following thoracic surgery that frequently occurs in patients ≥65 years. PND includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). To investigate whether intravenous dexmedetomidine (DEX) is able to improve neurocognitive function in elderly male patients following thoracoscopic lobectomy, a randomized, double-blinded, placebo-controlled trial was performed at the Affiliated Hospital of Inner Mongolia Medical University (Hohhot, China). Patients aged ≥65 years were enrolled and were subjected to thoracic surgery under general anesthesia. A computer-generated randomization sequence was used to randomly assign patients (at a 1:1 ratio) to receive either intravenous DEX (0.5 µg/kg per h, from induction until chest closure) or placebo (intravenous normal saline). The primary endpoint was the result of the Mini-Mental State Examination (MMSE). The secondary endpoints were the results of the Montreal Cognitive Assessment (MoCA) and those obtained with the Confusion Assessment Method (CAM), as well as the incidence of POCD and POD during the first 7 postoperative days. Other observational indexes included sleep quality at night, self-anxiety scale prior to the operation and 7 days following the operation and the visual analogue scale (VAS) score at rest and during movement on the first and third day following the operation. Furthermore, at 6 h following surgery, the MMSE score in the DEX group was significantly higher than that in the saline group. At 6 h and on the first day postoperatively, the MoCA score in the DEX group was significantly higher than that in the saline group. The incidence of POCD and POD in the DEX group was 13.2 and 7.5%, respectively, while that in the saline group was 35.8 and 11.3%, respectively. There was a significant difference in the incidence of POCD between the two groups (P<0.01). In the DEX group, mean sleep quality was increased, whereas the mean VAS was decreased compared with the corresponding values in the saline group. In conclusion, elderly male patients who underwent thoracoscopic lobectomy under continuous infusion of DEX (0.5 µg/kg/h) exhibited a reduced incidence of POCD during the first 7 postoperative days as compared with the placebo group. Furthermore, DEX improved the subjective sleep quality in the first postoperative night, reduced anxiety and alleviated postoperative pain. In addition, it increased the incidence of bradycardia. The present study was registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ; registration no. ChiCTR-IPR-17010958).
This retrospective study explored the efficacy and safety of dexmedetomidine in treating early postoperative cognitive dysfunction (EPPNCD) after video-assisted thoracoscopic lobectomy (VATL) in elderly male patients with lung cancer (LC). This study included a total of 80 elderly male patients with LC who received VATL. All of them were equally assigned to a treatment group and a control group, with 40 patients each group. The primary outcome included cognitive dysfunction, as evaluated by mini-mental state examination scale. The secondary outcomes consisted of incidence of EPPNCD, lung function (as measured by forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, and maximal voluntary ventilation), and adverse events. All outcome data were analyzed before and 3 days after surgery. After surgery, all patients in the treatment group exerted better efficacy in mini-mental state examination scale ( P < .01) and incidence of EPPNCD ( P = .03), than patients in the control group. However, no significant differences were detected in forced vital capacity ( P = .65), forced expiratory volume in 1 second ( P = .50), peak expiratory flow ( P = .73), and maximal voluntary ventilation ( P = .27) between 2 groups. In addition, there is similar safety profile between 2 groups. The findings of this study showed that dexmedetomidine may benefit EPPNCD after VATL in elderly male patients with LC. Future studies are needed to warrant the present conclusions.
Background: Postoperative cognitive dysfunction (POCD) is the decline in cognitive ability that occurs between one week and one year following surgery. POCD has been reported to occur in 5% to 26% of elderly surgical patients and its incidence varies with demographic, clinical, and surgical variables. Previous studies have shown that dexmedetomindine (DEX), a highly selective α2 adrenergic receptor agonist, has many effects that include opioid-sparing properties, decreased required anesthetic medication, and neuroprotection in animal models. Ultimately, DEX may benefit cognitive ability in the postoperative period. Therefore, we hypothesized that intraoperative infusion of DEX would reduce early POCD and interleukin-6 (IL-6) levels in elderly surgical patients compared to placebo. Methods: This randomized, double-blind, controlled trial enrolled 96 elderly patients that underwent video-assisted thoracoscopic lobectomy (VATL) between May 2017 and April 2018. The enrolled subjects were randomly assigned in a 1:1 ratio to receive intravenous dexmedetomidine (DEX Group) or placebo (0.9% normal saline, Saline Group) as a continuous infusion at a rate of 0.5μg/kg/hr starting at anesthesia induction until incision closure. All subjects received total intravenous anesthesia (TIVA) during surgery and patient controlled epidural analgesia (PCEA) following surgery. The primary outcomes were to determine the incidence of POCD and IL-6 expression at postoperative day (POD) 1, 2, and 7. The secondary outcomes were to evaluate the degree of pain on POD 1 and 2, as well as adverse events throughout the study. Results: 96 eligible subjects (48 per group) were randomized, dosed with study medication, and evaluated per protocol. There was a significant difference on POCD between the DEX and saline groups on POD 1 (6.3% vs. 20.8%, p-value <0.05) and POD 2 (4.2% vs. 16.7%, p-value <0.05). The IL-6 levels were significantly lower in the DEX group when compared with saline group during POD 1 and 2 (p-value <0.05). IL-6 returned to baseline levels on POD 7. There was no significant difference in POCD on POD7, and overall there were no significant differences in the incidence of adverse events between both groups.Conclusions: The administration of intraoperative DEX in elderly patients undergoing VATL decreased the incidence of early POCD. Clinical Trial Registry: This study was registered on Chinese Clinical Trial Registry with the ID ChiCTR-IPR-17010958.
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