The effect of dexamethasone on cognitive decline after cardiac surgery: a randomized clinical trial

Ottens, Thomas H.; Dieleman, Jan M.; Sauër, Anne-Mette C.; Nierich, Arno P.; Nathoe, Hendrik M.; Dijk, Diederik van

doi:10.1097/00003643-201406001-00330

Cited by 18 publications

(40 citation statements)

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“…Table 1 shows the characteristics of the included studies. Four of the included studies involved cardiac surgery [22][23][24][25], while the remaining one involved microvascular decompression surgery [26].…”

Section: Study Selectionmentioning

confidence: 99%

“…Four studies used a two-arm design in comparing dexamethasone to placebo except 1, which used a three-arm design [26]. Three studies assessed the effects of dexamethasone on POCD [22,24,26], while two studies investigated the effects of dexamethasone on POD [23,25].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies reported the incidence of POCD, in which data was reported as the number of participants [22,24,26]. Fang and 538 participants in placebo group, which accounted for 95% of the total 1460 enrolled participants.…”

Section: Incidence Of Pocdmentioning

confidence: 99%

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Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Fang

et al. 2019

Preprint

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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.

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Fang

et al. 2019

Preprint

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“…Пациенты пожилого и старческого возраста находятся в группе риска развития послеоперационной когнитивной дисфункции. Оценка когнитивного статуса должна проводиться до операции и в послеоперационный период [105][106][107] Уровень достоверности (доказательности) В Уровень убедительности рекомендации I дексаметазон [119], а также ишемическое прекондиционирование [120] могут потенциально снизить частоту ПОКД. Кроме того, сочетанное применение мониторинга биспектрального индекса и церебральной оксиметрии также, возможно, может быть полезно в профилактике данного осложнения [121].…”

Section: положение 11unclassified

Perioperative management of geriatric patients

Zabolotskikh¹,

Горобец²,

Grigoriev³

et al. 2018

Anesteziologiya I Reanimatologiya

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1 ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия 2 ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Москва, Россия 3 ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России, Кемерово, Россия 4 ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.В. Владимирского», Москва, Россия 5 ФГБОУ ВО РНИМУ им. Н.И. Пирогова ОСП «Российский геронтологический научно-клинический центр», Москва, Россия 6 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия 7 ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России, Москва, РоссияОбщеизвестно, что по сравнению с молодыми пациентами люди старше 60 лет имеют более высокий риск развития неблагоприятных послеоперационных исходов в результате связанного с возрастом изменения физиологических функций, наличия нескольких сопутствующих заболеваний, полипрагмазии, когнитивной дисфункции и специфических гериатрических синдромов, таких как хрупкость. Более 1 / 4 этой категории лиц имеют по несколько хронических заболеваний сердечно-сосудистой, нервной, эндокринной, кроветворной, опорно-двигательной систем, органов дыхания, пищеварения. В процессе старения наступают также снижение и некоторое извращение обменных процессов, уменьшение функциональных резервов организма. Все вышесказанное наряду с объемом оперативного вмешательства увеличивает риск развития послеоперационных осложнений и периоперационной летальности. Целью разработки настоящих руководящих принципов является обобщение современных данных о периоперационном ведении пациентов пожилого и старческого возраста. Они включают рекомендации по предоперационной оценке, в том числе нейропсихиатрической, необходимым диагностическим мероприятиям, выбору метода анестезии и особенностямх ее проведения, а также профилактике периоперационных осложнений.Ключевые слова: пациенты пожилого и старческого возраста, периоперационное ведение, анестезия, старческая астения, нутриционная недостаточность, когнитивные нарушения.Для корреспонденции: Заболотских Игорь Борисович, д.м.н., проф., заведующий кафедрой анестезиологии, реаниматологии и трансфузиологии ФПК и ППС Кубанского государственного медицинского университета;

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“…Remacemide, another NMDA receptor antagonist, was shown to provide minimal protection against POCD at 8 weeks after cardiac surgery . Recently, a large prospective trial using high‐dose dexamethasone to obtund the inflammatory response in cardiac surgery failed to reduce the incidence of POCD …”

Section: Therapeutic Strategies For Pocdmentioning

confidence: 99%

The impact of the peri‐operative period on cognition in older individuals

Evered

Silbert

Scott

2015

Pharmacy Practice and Res

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This review aims to highlight the importance of peri-operative and longer-term postoperative cognitive changes and to put them in the context of other cognitive disorders. Cognitive decline is common among the elderly and is impacted by many factors, both known and unknown. Individuals aged 65 years and above comprise the most frequent users of the healthcare system; thus this group is at risk of both cognitive decline associated with ageing, such as mild cognitive impairment and Alzheimer's disease, and cognitive disorders associated with surgery and anaesthesia, including delirium and postoperative cognitive dysfunction. Until now research and management of geriatric cognitive disorders has occurred in isolation from peri-operative medicine and research, such that any overlap between the cognitive disorders has been largely overlooked. Factors contributing to this division include the classification of geriatric cognitive disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) criteria, while cognitive disorders associated with the peri-operative period are largely research diagnoses. Given the large overlap between individuals at risk of cognitive decline (those aged 65 or above) and individuals exposed to surgery and anaesthesia, consideration of the role of the peri-operative period in geriatric cognitive disorders is imperative. Recent work investigating postoperative cognitive dysfunction has identified baseline cognitive function as a more significant predictor of further decline than increasing age, suggesting that preoperative cognitive trajectory may be the most important factor in determining postoperative decline. Both animal and human data provide evidence of a role of inflammation in cognitive decline, although this area requires further research to definitively identify associations and possible therapeutic strategies. Given the ageing population and the associated healthcare costs of caring for an increasing number of individuals suffering cognitive decline, any insults that exacerbate this problem need to be avoided. Understanding the overlap between geriatric and postoperative cognitive disorders is essential to ensure appropriate healthcare management of the elderly.

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The effect of dexamethasone on cognitive decline after cardiac surgery: a randomized clinical trial

Cited by 18 publications

References 0 publications

Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

Perioperative management of geriatric patients

The impact of the peri‐operative period on cognition in older individuals

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