Comparison between the Effects of Dexmedetomidine and Midazolam on Postoperative Cognitive Impairment after Coronary Artery Bypasses Graft Surgery: A Randomized Clinical Trial

Abstract

Background: Postoperative cognitive decline is a common complication observed frequently after general anesthesia in the immediate postoperative phase. We studied the effects of dexmedetomidine versus midazolam during coronary artery bypass graft (CABG) surgery on cognitive and memory function. 
 Methods: In this clinical trial, 42 elective on-pump CABG candidates under general anesthesia, aged between 40 and 65 years, were enrolled randomly in 2 groups. Group A received 0.05–0.1 mg/kg of midazolam and Group B received 1 µg/kg of dexmedetomidine. One day before surgery, all the participants underwent the Persian version of the Mini-Mental State Examination (MMSE) and the Persian version of the Wechsler Memory Scale (WMS) test for a comparison of cognitive impairment and memory functions. Both groups were given fentanyl and propofol for the induction of anesthesia and muscle relaxants. The MMSE and WMS tests were repeated 5 and 30 days after surgery.
 Results: The mean±SD of age was 55.47±7.18 y in Group A and 55.39±6.08 y in Group B. Eighty percent of the participants were men in both groups. There were no significant differences between Group A and Group B in the MMSE and WMS before surgery (89.04±14.30 vs. 97.10±18.10, respectively; P=0.059), but the WMS was significantly different 30 days after surgery (87.60±14.30 vs. 103.53±19.93, respectively; P=0.005). Group A showed high cognitive impairment and low WMS scores compared with Group B (P=0.005). Additionally, the MMSE results were not statistically different between the 2 groups postoperatively (24.80±3.18 vs. 23.55±4.18, respectively; P=0.394).
 Conclusion: Our results showed that dexmedetomidine might have a lower impact on cognitive function than might midazolam among patients undergoing CABG.
 
 J Teh Univ Heart Ctr 2019;14(2):67-73
 
 This paper should be cited as: Rajaei M, Tabari M, Soltani G, Alizadeh K, Nazari A, Noroozian M, Morovatdar N. Dexmedetomidine and Midazolam on Postoperative Cognitive Impairment after Coronary Artery Bypasses Graft Surgery: A Randomized Clinical Trial. J Teh Univ Heart Ctr 2019;14(2):67-73.

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

“…This study found that the incidence of POCD in group A was significantly higher than that in the other three groups, which has minor damage to central cholinergic neurons and projection fibers. Besides, it has a specific alleviating effect on the cognitive function mediated by acetylcholine, such as sensation, feeling, learning, arousal, and judgment [ 20 , 21 ]. Furthermore, awakening time from anesthesia is shorter than group A.…”

The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Cardiac Surgery

“…Abstract screening excluded 254 citations because of incorrect study design (n = 152), ineligible study population (n = 93), a lack of cognitive outcome assessment (n = 3), no utilization of DEX (n = 2), or unavailability of the full text (n = 4). Ten full-text articles were retrieved 33–42 . One article was excluded after retrieval because we were unable to determine if cognitive function was assessed and authors did not respond to inquiries 33 .…”

“…The characteristics for the studies included in the qualitive and quantitative analyses are presented in Supplementary Appendix B, http://links.lww.com/SLA/D414. The 9 trials randomized 945 participants, of whom 471 received DEX and 474 did not 34–42 . The 7 trials included in the meta-analysis randomized 807 participants of whom 402 received DEX and 405 did not 34–40 …”

Effect of propofol‐based total intravenous anaesthesia on postoperative cognitive function and sleep quality in elderly patients

“…At present, the clinical assessment of postoperative cognitive dysfunction (POCD) is the MMSE, [14][15][16] Montreal cognitive assessment (MoCA) 17 and Wechsler Memory Scale (WMS). 16 Li et al 14 used MMSE on the relationship between ABO blood type and POCD in elderly patients undergoing unilateral total hip replacement. Han et al 15 confirmed that early POCD after tonsillectomy in children could be assessed using the MMSE.…”