Effect of dexmedetomidine on postoperative delirium in patients undergoing brain tumour resections: study protocol of a randomised controlled trial

Abstract

IntroductionPostoperative delirium (POD) is a common complication. The incidence of POD is about 25% in non-cardiac surgery and ranges from 10% to 30% in neurological procedures. A lot of trials show that dexmedetomidine might help to reduce the incidence of delirium in patients undergoing non-cardiac surgery. However, the impact of dexmedetomidine on POD for patients undergoing craniotomy and tumour resections remains unclear.Methods and analysisThe study is a prospective, single-centre, randomised, double-blinded, paralleled-group controlled trial. Patients undergoing elective frontotemporal tumour resections will be randomly assigned to the dexmedetomidine group and the control group. After endotracheal intubation, patients in the dexmedetomidine group will be administered with a loading dose of dexmedetomidine 0.6 µg/kg in 10 min followed by continuous infusion at a rate of 0.4 µg/kg/hour until the start of dural closure. In the control group, patients will receive the identical volume of normal saline in the same setting. The primary outcome will be the cumulative incidence of POD within 5 days. The delirium assessment will be performed by using the confusion assessment method in the first 5 consecutive days after surgery. Secondary outcomes include the pain severity assessed by Numerical Rating Scale pain score, quality of postoperative sleep assessed by the Richards Campbell sleep questionnaire and postoperative quality of recovery from anaesthesia by the Postoperative Quality Recovery Scale.Ethics and disseminationThe protocol (V.1.0, 10 November 2020) has been approved by the Ethics Review Committee of the Chinese Clinical Trial Registry (number ChiECRCT-20200436). The findings of the study will be disseminated in a peer-reviewed journal and at a scientific conference.Trial registration numberNCT04674241.

Effects of Dexmedetomidine on Cognitive Function, Oxidative Stress and Brain Protection in Patients Undergoing Craniocerebral Surgery

“…As a highly selective α 2adrenergic receptor agonist, dexmedetomidine has emerged for its diverse potentials and is widely applied in cranial surgery [19]. In patients undergoing cranial surgery, dexmedetomidine demonstrates the ability to mitigate anesthetic drug-related neurotoxicity, reduce intracranial pressure, enhance brain metabolism, minimize brain cell apoptosis and necrosis, inhibit the expression of excitatory neurotransmitters, alleviate postoperative pain, and promote overall postoperative recovery [20,21].…”

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

“…The treatment protocol has been previously reported. 6 We conducted a prospective follow-up visit and a secondary analysis to explore the effect of dexmedetomidine on chronic incisional pain. This article adheres to the Consolidated Standards of Reporting Trials (CONSORT) statement.…”

“…4,5 Previous studies have shown that dexmedetomidine provides effective postoperative early analgesia and reduced postoperative opioid requirements for different types of surgeries. [6][7][8][9] Furthermore, a meta-analysis indicated that dexmedetomidine relieved postoperative acute pain intensity and reduced perioperative analgesic consumption in neurosurgery, but the impact of dexmedetomidine on chronic pain needs further study. 10 It has been reported that postoperative acute pain correlates with an increased risk of chronic pain.…”

Effect of dexmedetomidine on postoperative delirium in patients undergoing awake craniotomies: study protocol of a randomized controlled trial

“…According to our previous study, the incidence of delirium after frontotemporal tumor resections is about 35% [ 26 ]. A meta-analysis indicated that Dex relatively alleviated the incidence of delirium by approximately 54% [ 27 ].…”