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In people undergoing thoracic
surgery, dexmedetomidine infusion in the perioperative period minimized
postoperative pain but was unable to improve cognitive performance.
A randomized, prospective trial published in BioMed Research International demonstrated that a low-dose perioperative infusion of dexmedetomidine in people undergoing elective thoracic surgery diminishes postsurgery pain, shortens the length of hospitalization, and minimizes the hospitalization expenses. However, it did not lower occurrence of early postoperative cognitive dysfunction (POCD).
Jiao Ran et al. aimed to investigate if dexmedetomidine infusion in the perioperative period decreases the occurrence of early POCD in people undergoing surgery. In this double-blind, placebo-controlled trial, 126 participants (aged 45 years or older) were randomized to receive an infusion of either dexmedetomidine (n=63) or saline placebo (n=63) during surgery.
Evaluation of postsurgery cognitive impairment was done. Infusion of dexmedetomidine was done at a loading dose of 0.5 μg/kg intravenously (15 minutes after entering the operating room). After this, a continuous infusion at a rate of 0.5 μg/kg/h was carried out until one-lung ventilation or artificial pneumothorax terminated.
Subjects in the dexmedetomidine group were given regular patient-controlled intravenous analgesia (PCIA) pump with an additional 200 μg dose of dexmedetomidine. Overall, 102 people were incorporated in the result assessment. In terms of POCD occurrence, no profound differences were noted between the study groups.
When compared to the normal saline group, participants in the dexmedetomidine group illustrated reduced visual analogue scale (VAS) scores (1 day after surgery at rest and during activity), shorter length of stay in the intensive care unit, and reduced expenses, as shown in Table 1:
Regarding the telephone Interview for Cognitive Status-Modified (TICS-m) scores at different times, no notable inter-group differences were reported. But, the TICS-m score at seven days following operation was substantially reduced when compared to TICS-m score at 30 days in 102 people (32.93 ± 0.42 vs. 33.92 ± 0.47).
At seven and thirty days after
surgery, participants in both groups exhibited comparable activities of daily
living (ADL) scores. However, the ADL score at thirty days following surgery
indicated a considerable decline in comparison with that at seven days.
BioMed Research International
Role of Dexmedetomidine in Early POCD in Patients Undergoing Thoracic Surgery
Jiao Ran et al.
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