Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: A randomized double blinded controlled trial

Abstract

Study objectiveTo evaluate effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy.DesignRandomized, double-blind study.SettingUniversity-affiliated teaching hospital.PatientsOne hundred and fifty-two elderly patients scheduled for shoulder arthroscopy.InterventionsAt 15 min before the induction of anesthesia, 152 patients received intravenously parecoxib sodium 40 mg and dexmedetomidine at a dose of 0.5 μg/kg over 15 min, followed by a continuous infusion at a rate of 0.5 μg/kg/h until the end of surgery. Then all patients who received postoperative patient-controlled intravenous analgesia were divided 2 groups: sufentanil(0.04μg/kg/h, S group), sufentanil (0.04μg/kg/h) plus dexmedetomidine(0.06μg/kg/h) (SD group).MeasurementsThe mini–mental status examination score in SD group was significantly higher than S group at 1, 2 and 7 days after surgery. The incidence of postoperative cognitive dysfunction during 7 days after surgery in S and SD groups was respectively 17.1% and 6.7%. Compared with the S group, the visual analogue scale scores at rest and upon movement were significantly lower at 6, 14, 24, 36 and 48 h after surgery in SD group; analgesia pump liquid amount during 24 h after surgery and number of rescue analgesia during 48 h after surgery were significantly lower in SD group. Jugular venous oxygen partial pressure and jugular venous oxygen saturation values in SD group were significantly higher than S group at postoperative 24 h. The occurrence of nausea and vomiting within 48 h after surgery in SD group were significantly lower than S group. We found no complications including respiratory depression and sinus bradycardia within 48 h after surgery in all patients.ConclusionsParecoxib sodium pretreatment combined with dexmedetomidine could reduce the incidence of early postoperative cognitive dysfunction in elderly patients. This might be related to the improvement of postoperative analgesia effect and cerebral oxygen metabolism in patients.

Effects of remifentanil-propofol combined with dexmedetomidine on cognitive dysfunction in elder patients after ureteroscopic holmium laser lithotripsy: A double-blind randomized controlled trial

“…These ndings are compatible with the results of our study that dexmedetomidine has no effects on postoperative cognitive function in elderly patients anaesthetized with remifentanil and propofol. Several studies have demonstrated that dexmedetomidine may bene t cognitive function in elderly patients due to its neuroprotective effect and inhibiting inflammation 24,26,27 . In our study, we didn't detect the Plasma in ammatory factors, and the effect of dexmedetomidine on plasma in ammatory mediators in elderly patients was unclear.…”

“…We didn't detect the Plasma in ammatory factors in our study. Many studies have reported that the protective effect of dexmedetomidine on cognitive function due to its inhibiting inflammation [24][25][26] . The patients selected in our study had almost no postoperative pain, so the effects of remifentanil-propofol combined with or without dexmedetomidine on cognitive dysfunction in elder patients with postoperative pain were unclear.…”

Lack of Equipoise on Ankle Block after Hallux Valgus Surgery?

“…The authors performed a prospective randomized study on 60 patients undergoing hallux valgus surgery and concluded that ankle block added to general anesthesia may improve early and mid-term postoperative functional outcomes and postoperative pain management in patients who undergo hallux valgus surgery. The authors should be congratulated for performing a study on an important topic in patients undergoing orthopedic surgery [2]. Moreover, the current emphasis on the need to use nonopioid strategies to improve postoperative pain makes the subject very relevant to perioperative medicine [3,4].…”

Bone marrow mesenchymal stem cells regulate TGF‐β to adjust neuroinflammation in postoperative central inflammatory mice

“…1 Postoperative cognitive dysfunction (POCD) has attracted extensive attention, which generally manifests as amentia, anxiety, personality changes, sociability decline, and memory impairment. 1 Postoperative cognitive dysfunction (POCD) has attracted extensive attention, which generally manifests as amentia, anxiety, personality changes, sociability decline, and memory impairment.…”

“…Thus, it has severely affected the postoperative recovery and health of patients. 1 However, the precise mechanism of action of POCD remains unclear at present, and the aged patients have more severe POCD. 3 The incidence within 1 week and 3 months after surgery are as high as 47.3% and 6.3%, respectively.…”