Intraoperative dexmedetomidine infusion might help to preserve the cognitive function of geriatric patients undergoing arthroscopic shoulder surgery

Abstract

Objectives: This study tried to evaluate the impact of dexmedetomidine (DXM) infusion provided during sevoflurane (SEV) anesthesia on cognitive function (CF) of elderly patients undergoing elective arthroscopic shoulder surgeries. Patients & Methods: A total of 140 patients were randomly allocated into Groups S and D. All patients received SEV (0.5–1 MAC) with placebo or DXM (0.6 µg/kg/h) infusions, respectively. CF was evaluated preoperatively, 48-h, 1-wk, and 2-wk postoperative (PO) using the Montreal Cognitive Assessment Test and Mini-Mental State Examination (MMSE). The study outcome is the frequency and severity of PO cognitive dysfunction (POCD). Results: At 48-h PO, the frequency of normal CF and scorings were significantly decreased compared to preoperative findings, but were significantly higher in group D. At 1-wk PO, the frequency of normal CF and scores increased in both groups with significant difference in favor of group D, but differences were significantly lower than in preoperative measures. At 2-wk PO, 79.3% of patients regained their normal CF, with significantly higher frequency and score for group D, and the difference compared to preoperative data was insignificant in group D, but it was significant in group S. At 48-h, scorings were positively related to using DXM but were negatively related to age, obesity, and PO analgesia. Regression analysis defined old age as negative and the use of DXM as positive predictor for high scores. Conclusion: SEV anesthesia induced reversible short-term POCD. Coupling of DXM infusion with SEV anesthesia decreased the frequency and scores of POCF and fastened resumption of normal CF.