Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial
Weiwei Liu,* Yiru Wang,* Kaizheng Chen,* Min Ye, Weisha Lu, Keyu Chen, Xia Shen Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xia Shen,...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-09-01
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| Series: | Drug Design, Development and Therapy |
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| Online Access: | https://www.dovepress.com/effect-of-intraoperative-dexmedetomidine-use-on-postoperative-delirium-peer-reviewed-fulltext-article-DDDT |
| _version_ | 1797674951628554240 |
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| author | Liu W Wang Y Chen K Ye M Lu W Chen K Shen X |
| author_facet | Liu W Wang Y Chen K Ye M Lu W Chen K Shen X |
| author_sort | Liu W |
| collection | DOAJ |
| description | Weiwei Liu,* Yiru Wang,* Kaizheng Chen,* Min Ye, Weisha Lu, Keyu Chen, Xia Shen Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xia Shen, Department of Anesthesiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People’s Republic of China, Email shenxiash@fudan.edu.cnPurpose: To examine whether intraoperative dexmedetomidine reduces postoperative delirium (POD) in elderly patients who underwent a laryngectomy.Methods: Patients were randomly assigned to receive dexmedetomidine or a saline placebo infused during surgery. The study period was July 2020 to January 2022. Participants were elderly individuals (≥ 65 years) who underwent a laryngectomy. Immediately after induction of anesthesia, a 0.5 μg.kg− 1 bolus of study solution was administered for 10 min, followed by a maintenance infusion of 0.2 μg.kg− 1.hr− 1 until the end of surgery. Patients were assessed daily for POD (primary outcome). Plasma inflammatory factors were measured at baseline, on the first postoperative day, and on the third postoperative day.Results: In total, 304 male patients were randomized; 299 patients [median (interquartile range) age, 69.0 (67.0– 73.0) years] completed in-hospital delirium assessments. There was no difference in the incidence of POD between the dexmedetomidine and control groups (21.3% [32 of 150] vs 24.2% [36 of 149], P=0.560). However, dexmedetomidine reduced POD in patients with laryngeal cancer and a higher tumor stage (21.6% vs 38.5%; OR, 0.441; 95% CI, 0.209– 0.979; P=0.039). Dexmedetomidine reduced levels of C-reactive protein (CRP) (P=0.0056) and interleukin 6 (IL-6) (P< 0.001) on the first and third postoperative days, respectively. More patients had intraoperative hypotension in the dexmedetomidine group (29.3% [44 of 150] vs 17.4% [26 of 149], P=0.015).Conclusion: Intraoperative dexmedetomidine administration did not prevent POD in patients with laryngeal cancer. Dexmedetomidine reduced serum CRP and IL-6 levels postoperatively but caused a higher occurrence of intraoperative hypotension in elderly patients after a laryngectomy.Keywords: dexmedetomidine, laryngectomy, postoperative delirium, inflammatory factors, surgery complication |
| first_indexed | 2024-03-11T22:07:37Z |
| format | Article |
| id | doaj.art-1e13a02fd36d4cb99572189a33634813 |
| institution | Directory Open Access Journal |
| issn | 1177-8881 |
| language | English |
| last_indexed | 2024-03-11T22:07:37Z |
| publishDate | 2023-09-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Drug Design, Development and Therapy |
| spelling | doaj.art-1e13a02fd36d4cb99572189a336348132023-09-24T18:07:22ZengDove Medical PressDrug Design, Development and Therapy1177-88812023-09-01Volume 172933294186898Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical TrialLiu WWang YChen KYe MLu WChen KShen XWeiwei Liu,* Yiru Wang,* Kaizheng Chen,* Min Ye, Weisha Lu, Keyu Chen, Xia Shen Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xia Shen, Department of Anesthesiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People’s Republic of China, Email shenxiash@fudan.edu.cnPurpose: To examine whether intraoperative dexmedetomidine reduces postoperative delirium (POD) in elderly patients who underwent a laryngectomy.Methods: Patients were randomly assigned to receive dexmedetomidine or a saline placebo infused during surgery. The study period was July 2020 to January 2022. Participants were elderly individuals (≥ 65 years) who underwent a laryngectomy. Immediately after induction of anesthesia, a 0.5 μg.kg− 1 bolus of study solution was administered for 10 min, followed by a maintenance infusion of 0.2 μg.kg− 1.hr− 1 until the end of surgery. Patients were assessed daily for POD (primary outcome). Plasma inflammatory factors were measured at baseline, on the first postoperative day, and on the third postoperative day.Results: In total, 304 male patients were randomized; 299 patients [median (interquartile range) age, 69.0 (67.0– 73.0) years] completed in-hospital delirium assessments. There was no difference in the incidence of POD between the dexmedetomidine and control groups (21.3% [32 of 150] vs 24.2% [36 of 149], P=0.560). However, dexmedetomidine reduced POD in patients with laryngeal cancer and a higher tumor stage (21.6% vs 38.5%; OR, 0.441; 95% CI, 0.209– 0.979; P=0.039). Dexmedetomidine reduced levels of C-reactive protein (CRP) (P=0.0056) and interleukin 6 (IL-6) (P< 0.001) on the first and third postoperative days, respectively. More patients had intraoperative hypotension in the dexmedetomidine group (29.3% [44 of 150] vs 17.4% [26 of 149], P=0.015).Conclusion: Intraoperative dexmedetomidine administration did not prevent POD in patients with laryngeal cancer. Dexmedetomidine reduced serum CRP and IL-6 levels postoperatively but caused a higher occurrence of intraoperative hypotension in elderly patients after a laryngectomy.Keywords: dexmedetomidine, laryngectomy, postoperative delirium, inflammatory factors, surgery complicationhttps://www.dovepress.com/effect-of-intraoperative-dexmedetomidine-use-on-postoperative-delirium-peer-reviewed-fulltext-article-DDDTdexmedetomidinelaryngectomypostoperative deliriuminflammatory factorssurgery complication |
| spellingShingle | Liu W Wang Y Chen K Ye M Lu W Chen K Shen X Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial Drug Design, Development and Therapy dexmedetomidine laryngectomy postoperative delirium inflammatory factors surgery complication |
| title | Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial |
| title_full | Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial |
| title_fullStr | Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial |
| title_full_unstemmed | Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial |
| title_short | Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial |
| title_sort | effect of intraoperative dexmedetomidine use on postoperative delirium in the elderly after laryngectomy a randomized controlled clinical trial |
| topic | dexmedetomidine laryngectomy postoperative delirium inflammatory factors surgery complication |
| url | https://www.dovepress.com/effect-of-intraoperative-dexmedetomidine-use-on-postoperative-delirium-peer-reviewed-fulltext-article-DDDT |
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