Effects of propofol, dexmedetomidine, and midazolam on postoperative cognitive dysfunction in elderly patients

Abstract

Background: Postoperative cognitive dysfunction (POCD) is a serious complication after surgery, especially in elderly patients. The anesthesia technique is a potentially modifiable risk factor for POCD. This study assessed the effects of dexmedetomidine, propofol or midazolam sedation on POCD in elderly patients who underwent hip or knee replacement under spinal anesthesia. Methods: The present study was a prospective randomized controlled preliminary trial. From July 2013 and December 2014, a total of 164 patients aged 65 years or older who underwent hip or knee arthroplasty at China-Japan Friendship Hospital and 41 non-surgical controls were included in this study. Patients were randomized in a 1:1:1 ratio to 3 sedative groups. All the patients received combined spinal-epidural anesthesia (CSEA) with midazolam, dexmedetomidine or propofol sedation. The sedative dose was adjusted to achieve light sedation (bispectral index[BIS] score between 70 and 85). All study participants and controls completed a battery of 5 neuropsychological tests before and 7 days after surgery. One year postoperatively, the patients and controls were interviewed over the telephone using the Montreal cognitive assessment 5-minute protocol. Results: In all, 60 of 164 patients (36.6%) were diagnosed with POCD 7 days postoperatively, POCD incidence in propofol group was significantly lower than that in dexmedetomidine and midazolam groups (18.2% vs. 40.0%, 51.9%, χ 2 = 6.342 and 13.603, P = 0.012 and < 0.001). When the patients were re-tested 1 year postoperatively, the incidence of POCD was not significantly different among the 3 groups (14.0%, 10.6% vs. 14.9%, χ 2 = 0.016 and 0.382, P = 0.899 and 0.536). Conclusion: Among dexmedetomidine, propofol and midazolam sedation in elderly patients, propofol sedation shows a significant advantage in term of short-term POCD incidence.

Dexmedetomidine for early postoperative cognitive dysfunction after video-assisted thoracoscopic lobectomy in elderly male patients with lung cancer

“…However, a lot of patients with LC who underwent VATL and dexmedetomidine experienced many complications, such as EPPNCD. [ 17 – 24 ] In addition, few data are available regarding the dexmedetomidine on EPPNCD after VATL in elderly male patients with LC.…”

“…[ 17 – 21 ] Studies suggested that it can benefit EPPNCD after VATL. [ 22 – 24 ] However, there is still limited data available regarding the efficacy and safety of dexmedetomidine on EPPNCD after VATL in elderly male patients with LC. Thus, this retrospective study investigated the efficacy and safety of dexmedetomidine on EPPNCD after VATL in elderly male patients with LC.…”

Acupuncture for perioperative care of total hip arthroplasty

“…[19–22] Even the use of anticoagulant and other alternative analgesics can reduce the side effects, not every patient is completely satisfied. [23,24] So the development of non-pharmacologic and alternative interventions is necessary.…”

Sensations of patients and their satisfaction during awake craniotomy

“…Во-первых, мидазолам угнетает дыхание, в особенности при внутривенном введении и комбинации с опиоидами [50,51]. Во-вторых, у возрастных пациентов и с измененным когнитивным фоном мидазолам может вызвать послеоперационную когнитивную дисфункцию или даже делирий [52]. Недавно FDA официально распространило предупреждение о возможном эффекте бензодиазепинов -развитии послеоперационной когнитивной дисфункции, о чем рекомендуется информировать пациентов перед операцией.…”