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Dexmedetomidine reduces postoperative delirium after joint replacement in elderly patients with mild cognitive impairment

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Abstract

Background and aims

Postoperative delirium (POD) is a common and serious surgical complication among the elderly, especially in those with amnestic mild cognitive impairment (aMCI). Dexmedetomidine (DEX) is neuroprotective for delirium. In this study, we determined the effect of intravenously administered DEX during general anesthesia on POD in elderly aMCI patients undergoing elective hip joint or knee joint or shoulder joint replacement surgery.

Methods

This was a prospective, randomized parallel-group study of aMCI (n = 80) and normal elderly patients (n = 120). Prior to surgery, all subjects underwent neuropsychological assessment and were assigned to one of four groups: the aMCI DEX group (MD group, n = 40), the aMCI normal saline group (MN group, n = 40), the control DEX group (CD group, n = 60), and the control normal saline group (CN group, n = 60). The confusion assessment method was used to screen POD on postoperative days 1, 3, and 7.

Results

We found patients age was positively correlated with POD incidence in the MN group (p < 0.05) but not in the CN group (p < 0.05). DEX treatment significantly decreased POD incidence in both control and aMCI groups relative to their respective placebo groups (all p < 0.05). The fraction of patients whose normal cognitive function was not restored by day 7 after surgery was significantly higher in the MN group than the MD and CN groups (all p < 0.05).

Conclusions

These findings suggested that DEX treatment during surgery significantly reduced POD incidence in both normal and aMCI elderly patients, suggesting that it may be an effective option for the prevention of POD.

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Authors and Affiliations

  1. Department of Anesthesiology, Beijing Military General Hospital, No. 5, Nanmencang, Dongcheng District, Beijing, 100700, People’s Republic of China

    Yongzhe Liu, Li Ma, Minglong Gao, Wenzhi Guo & Yaqun Ma

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  1. Yongzhe Liu
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  2. Li Ma
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  3. Minglong Gao
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  4. Wenzhi Guo
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  5. Yaqun Ma
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Correspondence to Yaqun Ma.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Liu, Y., Ma, L., Gao, M. et al. Dexmedetomidine reduces postoperative delirium after joint replacement in elderly patients with mild cognitive impairment. Aging Clin Exp Res 28, 729–736 (2016). https://doi.org/10.1007/s40520-015-0492-3

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  • DOI: https://doi.org/10.1007/s40520-015-0492-3

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