Effect Of Dexmedetomidine On Postoperative Delirium In Elderly Patients With Diabetes Mellitus

Objective: To evaluate the effect of dexmedetomidine on postoperative delirium(POD)in elderly patients with diabetes mellitus.Methods: Sixty-four elderly patients with diabetes mellitus of aged between 65-80 years old,American Society of Anesthesiologists physical status(ASA)/ ? ?,of no limitation on gender,scheduled for elective lumbar surgery under general anesthesia.All the selected patients were divided into two groups(n = 32)using a random number table: control group(Group C)and dexmedetomidine group(Group D).In group D,intravenous infusion of dexmedetomidine was started before anesthesia induction with a load of 0.5?g/kg,10 min infusion completed,then continuous infusion of 0.5?g/kg/h was given,and the infusion of dexmedetomidine was stopped 30 minutes before the end of operation.And group C was infused with the same amount of normal saline.Peripheral blood was drawn before administration of dexmedetomidine(T1),after tracheal intubation(T2),1 hour after skin incision(T3)and at the end of operation(T4),the concentrations of cortisol(COR),norepinephrine(NE),epinephrine(E),S100 ? protein,interleukin-6(IL-6)and C-reactive protein(CRP)were measured by ELISA.Using the CAM-ICU method to record the postoperative delirium in 2 groups within 3 days after operation.Results: Compared with T1,the concentrations of Cor,NE and E and S100 ? protein,IL-6 and CRP in the two groups increased at T2-T4(P<0.05);compared with group C,the concentrations of Cor,NE and E,S100 ? protein,IL-6 and CRP in group D decreased at T2-T4(P<0.05),and the dosage of general anesthesia maintenance drugs decreased during operation(P<0.05),the incidence of postoperative delirium decreased(P<0.05).Conclusion: Dexmedetomidine can reduce the incidence of postoperative delirium in the elderly patients with diabetes mellitus,and its mechanism may be related to the inhibition of stress response and inflammatory response during operation,the reduction of brain injury,and the reduction of the amount of general anesthesia maintenance drugs during operation.