Effects of Dexamethasone on Post-Operative Cognitive Dysfunction and Delirium in Adults Following General Anaesthesia: A Meta-Analysis of Randomised Controlled Trials

Abstract

Background Several studies have investigated the effects of dexamethasone on postoperative cognitive dysfunction (POCD) or postoperative delirium (POD); however, their conclusions have not been consistent. So we conducted a meta-analysis to determine the effects of dexamethasone on POCD/POD in adults following general anesthesia. Methods Cochrane Central Register of Controlled Trials (CENTRAL, 2018, Issue 11 of 12) in the Cochrane Library (searched November 17, 2018); MEDLINE OvidSP (1946 to November 16, 2018); and Embase OvidSP (1974 to November 16, 2018) were searched for randomized controlled trials that evaluated the incidence of POCD/POD following dexamethasone administration, in adults (age ≥18 years) under general anesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess the quality of evidence. Results Five studies were included (three studies/855 participants in dexamethasone group and 538 participants in placebo group for the incidence of POCD, and two studies/410 participants in dexamethasone group and 420 participants in placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD in 30 days after surgery (RR 1.00; 95% CI [0.51, 1.96], P = 1.00, I2 = 77%) or in the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I2 = 0%). However, both analyses had some limitations since evidence remains limited and clinical heterogeneity, and we considered the quality of the evidence for the postoperative incidence of POCD and POD to be very low. Conclusions This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative prevent strategies for POCD/POD, and a better understanding of the pathophysiology of those complex syndrome, are still needed to make progress of this field. Trial registration number: This study is registered with PROSPERO, 23 October 2018, number CRD42018114552.

Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

“…In addition, combined spinal-epidural anesthesia was also superior to general anesthesia with intubation in terms of postoperative cognitive function. We speculate that the relatively poor postoperative cognitive function of patients receiving general anesthesia with intubation was associated with the residual systemic analgesics, which might inhibit the central nervous system [16][17][18][19]. In addition to analgesics, pain may also contribute to the development of postoperative cognitive dysfunction [20][21][22].…”

Association Between Dexamethasone and Delirium in Critically ill Patients: A Retrospective Cohort Study of a Large Clinical Database

“…However, there are a large number of studies demonstrating that the occurrence of POD in patients using DEX is not signi cantly different from that in patients not using it [14,20,31,32]. The occurrence of POD is the result of the interaction of multiple factors, and a single intervention cannot completely affect it.…”

“…The occurrence of POD is the result of the interaction of multiple factors, and a single intervention cannot completely affect it. Although there is evidence that in ammation is an important pathogenesis of POD, other factors that have not been clari ed may play a greater role in the occurrence and development of POD [14,33], such as surgical factors, anesthetic drugs, especially benzodiazepines, which have been shown to seriously affect and exacerbate the occurrence of POD [31,34,35], and these factors are not present in most non-surgical critically ill ICU patients. It also explains why treatment with other antiin ammatory drugs such as statins [36] and haloperidol [37,38] does not appear to reduce the incidence of POD.…”

“…There is increasing evidence that the response of the brain to peripheral in ammation may play a role in the development of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) [13,14]. Dexamethasone (DEX) is a long-acting glucocorticoid widely used in various in ammatory diseases [15].…”

“…Dexamethasone (DEX) is a long-acting glucocorticoid widely used in various in ammatory diseases [15]. If the in ammatory reaction plays a role in the development of POD and POCD, then inhibiting the in ammatory response by DEX may prevent the development of POD and POCD [14,16]. However, other reports have demonstrated that high-dose oral glucocorticoid therapy increases the risk of psychiatric events, such as mood disorders, anxiety, aggressive behavior, insomnia, irritability, depersonalization, panic disorder, suicidal thoughts, dementia, and delirium [17,18].…”