Does Dexmedetomidine Ameliorate Postoperative Cognitive Dysfunction? A Brief Review of the Recent Literature
- 225 Downloads
Purpose of Review
Postoperative cognitive dysfunction (POCD) occurs in 20–50% of postsurgical patients with a higher prevalence in elderly patients and patients with vascular disease and heart failure. In addition, POCD has been associated with many negative outcomes, such as increased hospital length of stay, increased rates of institutionalization, and higher patient mortality. This brief review discusses select evidence suggesting an association between neuroinflammation and POCD and whether the use of dexmedetomidine, a short-acting alpha 2 agonist, may ameliorate the incidence of POCD. We review the recent evidence for neuroinflammation in POCD, dexmedetomidine’s properties in reducing inflammatory-mediated brain injury, and clinical studies of dexmedetomidine and POCD.
There is evidence to support the anti-inflammatory and immunomodulatory effects of dexmedetomidine in animal models. Several clinical investigations have demonstrated favorable outcomes using dexmedetomidine over placebo for the reduction of postoperative delirium. Few studies have used high-quality endpoints for the assessment of POCD and no demonstrable evidence supports the use of dexmedetomidine for the prevention of POCD.
While evidence exists for the neural anti-inflammatory properties of dexmedetomidine, human trials have yielded incomplete results concerning its use for the management of POCD. Dexmedetomidine may reduce acute postoperative delirium, but further studies are needed prior to recommending the use of dexmedetomidine for the direct reduction of POCD.
KeywordsDexmedetomidine Postoperative cognitive dysfunction Delirium Neuroinflammation
Compliance with Ethical Standards
Conflict of Interest
Zyad J. Carr, Theodore J. Cios, Kenneth F. Potter, and John T. Swick declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 1.Feinkohl I, Winterer G, Spies CD, Pischon T. Cognitive reserve and the risk of postoperative cognitive dysfunction. Deutsch Arztebl Int. 2017;114(7):110–7.Google Scholar
- 22.Funai Y, Pickering AE, Uta D, Nishikawa K, Mori T, Asada A, et al. Systemic dexmedetomidine augments inhibitory synaptic transmission in the superficial dorsal horn through activation of descending noradrenergic control: an in vivo patch-clamp analysis of analgesic mechanisms. Pain. 2014;155(3):617–28.CrossRefPubMedGoogle Scholar
- 26.Schomer KJ, Sebat CM, Adams JY, Duby JJ, Shahlaie K, Louie EL. Dexmedetomidine for refractory intracranial hypertension. J Intensive Care Med. 2017; https://doi.org/10.1177/0885066616689555.
- 27.Aouad MT, Zeeni C, Al Nawwar R, Siddik-Sayyid SM, Barakat HB, Elias S, et al. Dexmedetomidine for improved quality of emergence from general anesthesia: a dose-finding study. Anesth Analg. 2017.Google Scholar
- 28.Elbakry AE, Sultan WE, Ibrahim E. A comparison between inhalational (desflurane) and total intravenous anaesthesia (propofol and dexmedetomidine) in improving postoperative recovery for morbidly obese patients undergoing laparoscopic sleeve gastrectomy: a double-blinded randomised controlled trial. J Clin Anesth. 2017;45:6–11.CrossRefPubMedGoogle Scholar
- 34.•• Terrando N, Eriksson LI, Ryu JK, Yang T, Monaco C, Feldmann M, et al. Resolving postoperative neuroinflammation and cognitive decline. Ann Neurol. 2011;70(6):986–95. An elegant series of experiments detailing the effects of surgical related inflammation on the blood brain barrier and cognition. CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Qiao Y, Feng H, Zhao T, Yan H, Zhang H, Zhao X. Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC Anesthesiol. 2015;15:154.CrossRefPubMedPubMedCentralGoogle Scholar
- 50.• Yamanaka D, Kawano T, Nishigaki A, Aoyama B, Tateiwa H, Shigematsu-Locatelli M, et al. Preventive effects of dexmedetomidine on the development of cognitive dysfunction following systemic inflammation in aged rats. J Anesth. 2017;31(1):25–35. Yamanaka demonstrates that pre-systemic insult treatment with dexmedetomidine may mitigate neuroinflammation in a rat model of cognitive dysfunction. CrossRefPubMedGoogle Scholar
- 52.Xu KL, Liu XQ, Yao YL, Ye MR, Han YG, Zhang T, et al. Effect of dexmedetomidine on rats with convulsive status epilepticus and association with activation of cholinergic anti-inflammatory pathway. Biochem Biophys Res Commun. 2017.Google Scholar
- 62.•• Deiner S, Luo X, Lin HM, Sessler DI, Saager L, Sieber FE, et al. Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial. JAMA Surg. 2017;152(8):e171505. The most comprehensive clinical trial of dexemedetomidine for the treatment of postoperative cognitive dysfunction to date. CrossRefPubMedPubMedCentralGoogle Scholar
- 63.Weintraub S, Besser L, Dodge HH, Teylan M, Ferris S, Goldstein FC, et al. Version 3 of the Alzheimer disease centers’ neuropsychological test battery in the uniform data set (UDS). Alzheimer Dis Assoc Disord. 2017.Google Scholar