| Background and ObjectiveIn the context of an increasingly aging population,perioperative neurocognitive disorders have gradually become a common postoperative complication among older adults.After surgery,elderly patients often exhibit transient and reversible changes in cognitive function,which may even progress to dementia or death,severely affecting their quality of life.Therefore,it is crucial to find ways to prevent perioperative neurocognitive disorders in elderly patients.The aim of this study is to evaluate the impact of intravenous dexamethasone combined with dexmedetomidine during the perioperative period on the incidence of postoperative inflammation and cognitive dysfunction in elderly patients undergoing joint replacement surgery under general anesthesia.We will assess whether different drug treatments are associated with the incidence of postoperative delirium in elderly patients and provide evidence to support anesthesia providers in developing reasonable and personalized anesthesia plans for elderly patients in clinical practice,helping patients reduce or prevent the occurrence of PND and providing relevant clinical evidence.MethodsA total of 240 elderly patients aged 60-75 years who met the inclusion criteria will be selected from the Central People’s Hospital of Huizhou City,scheduled to undergo unilateral joint replacement surgery(including hip arthroplasty,total hip replacement,and knee arthroplasty)under endotracheal intubation general anesthesia from June 2020 to June 2022.Using a random number table,the patients will be assigned to one of four groups: a blank control group(CON group),a dexamethasone group(DS group),a dexmedetomidine group(DE group),or a dexmedetomidine+dexamethasone group(DD group),with 60 patients in each group.All patients will sign informed consent forms one day before surgery,and trained personnel will conduct bedside assessments of cognitive function using the Mini-Mental State Examination(MMSE)and3D-CAM detection.No preoperative medication will be administered to any patient.Upon admission,routine monitoring of electrocardiography(ECG),blood pressure(BP),oxygen saturation(Sp O2),and bispectral index(BIS)will be performed.A peripheral intravenous access will be established in the upper limb,and 5m L of peripheral venous blood will be drawn and intravenously administered to the CON and DE groups as 0.9% normal saline,while the DS and DD groups will receive intravenous dexamethasone 0.1 mg/kg(diluted to 5m L with 0.9% normal saline).All patients will receive continuous infusion of propofol,remifentanil,and intermittent administration of cisatracurium during anesthesia induction,with maintenance of muscle relaxation.The DD and DE groups will receive continuous infusion of dexmedetomidine at a dose of 0.5ug/kg/min during the maintenance phase of anesthesia,and dexmedetomidine will be discontinued 30 minutes before the end of surgery for both groups.Each group was given 5mg of tropisetron to prevent postoperative nausea and vomiting.Peripheral venous blood(5 m L)was collected from the patients at 30 minutes after extubation when the patients regained consciousness,as well as on postoperative day 3,and the serum IL-6 and S100-β levels were determined using the ELISA method.The 3D-CAM scale was used to evaluate the patients on the first,second,and third day after surgery.The primary outcome measure was the incidence of perioperative neurological dysfunction in each group,and the secondary outcome measures included serum IL-6 and S100-β levels at 30 minutes and on postoperative day 3,as well as the duration of surgery,anesthesia time,propofol and remifentanil dosage,postoperative NRS pain score,sufentanil dosage for postoperative analgesia,and perioperative complications.ResultsThe incidence of postoperative delirium(PND)was 37.2% in the CON group,28.1% in the DS group,26.3% in the DE group,and 20.3% in the DD group,with a significantly lower incidence in the DD group compared to the CON group(P<0.05).Compared to the preoperative levels,serum levels of IL-6 and S100-β were significantly increased at 30 minutes and 3 days after surgery in both groups(P<0.05).Compared to the CON group,serum levels of IL-6 and S100-βwere significantly decreased at 30 minutes and 3 days after surgery in the DS,DE,and DD groups(P<0.05).There were no significant differences in postoperative surgical time,anesthesia time,propofol and remifentanil doses,postoperative numerical rating scale(NRS)pain scores,postoperative sufentanil doses for analgesia,intraoperative hypotension and bradycardia,postoperative somnolence,nausea and vomiting,and postoperative hyperglycemia among the four groups.Serum levels of IL-6 at 30 minutes and 3 days after surgery were predictive factors for PND.The IL-6 levels on the third day after surgery were predictive factors for PND in the DD group.Logistic regression analysis of baseline characteristics of 232 patients revealed that gender and BMI were independent risk factors for PND.Conclusions1.The use of dexamethasone or dexmedetomidine alone during surgery can reduce the serum levels of IL-6 and S100-β and alleviate the inflammatory response in elderly patients undergoing joint replacement surgery,their combined use can results to a better effect.2.The combination of dexamethasone and dexmedetomidine can reduce the incidence of early postoperative delirium in elderly patients undergoing joint replacement surgery,and regression analysis suggests that this is related to the reduction of inflammatory response. |
PDF Full Text Request