Effects of propofol, dexmedetomidine, and midazolam on postoperative cognitive dysfunction in elderly patients: a randomized controlled preliminary trial  

作　　者：Wei-Xia Li Ru-Yi Luo Chao Chert Xiang Li Jing-Sheng AO Yue Liu Yi-Qing Yin 

机构地区：[1]Department of Anesthesiology,China-Japan Friendship Hospital,Beijing 100029,China [2]Department of Anesthesiology,The Second Xiangya Hospital of Central South University,Changsha,Hunan 410008,China [3]Department of Anesthesiology,Shantou Central Hospital,Shantou,Guangdong 515031,China [4]Department of Anesthesiology,Fu Xing Hospital,Capital Medical University,Beijing 100038,China

出　　处：《Chinese Medical Journal》2019年第4期437-445,共9页中华医学杂志（英文版）

摘　　要：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.

关 键 词：Cognitive dysfunction NEUROPSYCHOLOGICAL tests POSTOPERATIVE period SEDATIVES 

分 类 号：R[医药卫生]