The Effect and Optimal Dosage of Dexmedetomidine Plus Sufentanil for Postoperative Analgesia in Elderly Patients With Postoperative Delirium and Early Postoperative Cognitive Dysfunction: A Single-Center, Prospective, Randomized, Double-Blind, Controlled Trial

Abstract

Background: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications after major surgery among elderly patients. Dexmedetomidine (DEX) is less frequently explored for its effects in patients with postoperative neurocognitive disorders. This study investigated the effect and optimal dosage of DEX for patient-controlled analgesia (PCA) on POD and early POCD after major surgery among elderly patients. Methods: Patients in four groups received continuous infusion of DEX 0, 100, 200, and 400 µg with sufentanil 150 µg for PCA immediately after surgery. POD and POCD were assessed on postoperative days 1, 2, 3, and 7 by using the Confusion Assessment Method (CAM) and Mini-Mental State Examination (MMSE) scales. Furthermore, the incidence of POD and POCD of all the four groups in postoperative 7 days classified by high risk factors (age, education, surgical site, and surgical category), sedation level, postoperative pain intensity, and side effects were assessed. Results: The overall incidence rates of POD and early POCD 7 days after surgery were lower in the DEX 200 µg 400 µg groups than in the DEX 0 µg and 100 µg groups (P < 0.05). Compared with DEX 200 µg, DEX 400 µg reduced early POCD in patients who underwent open surgery (P < 0.05). There were no intergroup differences in the postoperative sedation level, pain intensity, and side effects.

Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Pain after Craniotomy: A Narrative Review

“…Furthermore, a systematic review by Halpin et al revealed a decrease in postoperative delirium in patients undergoing cardiac surgery receiving postoperative DEX in comparison with commonly used sedatives and analgesics [ 30 ]. This emphasizes that DEX as an anaesthetic adjuvant is not only beneficial in reducing postoperative pain but also effective in preventing postoperative delirium when used as an adjuvant both intraoperatively and postoperatively [ 29 , 30 , 31 ].…”

Post-Operative Cognitive Impairment: A Cognitive Epidemiology Perspective

“…To name one landmark study included in the meta-analysis, the International Study of Post-Operative Cognitive Dysfunction (ISPOCD 1), found that among 1011 older surgical patients recruited in eight European countries and the USA, patients with more than a high school education had even a halved risk of POCD at one week after surgery compared with patients with less than high school education ( Moller et al 1998 ). Studies from various European and Asian countries and the USA that were not included in the 2017 meta-analysis ( Grichnik et al 1999 ) or published thereafter ( Bendikaite and Vimantaite 2020 ; Ehsani et al 2020 ; Huang et al 2020a ; Klinger et al 2019 ; Li et al 2020 ; Wang et al 2018 ; Yuhe et al 2020 ; Zhang et al 2019 ; Zhou et al 2020 ) too, consistently indicate that patients with a lower educational level are at increased POCD risk at discharge ( Zhang et al 2019 ) within days of surgery ( Ehsani et al 2020 ; Li et al 2020 ; Zhao et al 2020 ; Zhou et al 2020 ) but also during six to 12 weeks after surgery ( Grichnik et al 1999 ; Yuhe et al 2020 ). The fact that observations extend to several months after surgery is important because studies on POCD with longer follow-up periods offer preferred scope for conclusions: during shorter follow-up periods immediate effects of surgery on brain function including a potential influence of POD can prevail.…”

Progress in Research on the Effect of Melatonin on Postoperative Cognitive Dysfunction in Older Patients

“…POCD is the result of various mechanisms, such as neuroinflammation, oxidative stress, dysfunction of neurotransmitters or their receptors, circadian rhythm disorders, iron overload ( Gögenur et al, 2007 ; Li et al, 2016 ; Netto et al, 2018 ; Luo et al, 2019 ; Wang C. M. et al, 2021 ). At present, the drugs for the prevention and treatment of POCD include non-steroidal anti-inflammatory drugs (parecoxib, acetaminophen, ibuprofen), anesthesia-related drugs (dexmedetomidine, etomidate, oxycodone), ulinastatin, desferrioxamine, antipsychotics, and so on ( Zhou et al, 2019 ; Gan et al, 2020 ; Huang et al, 2020 ; Yu and Xie, 2020 ; Zhao et al, 2020 ; Duan et al, 2021 ). However, there is still a lack of safe and effective ideal drugs.…”