Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis
Abstract Background Elderly patients are prone to postoperative cognitive dysfunction (POCD). The comparison of the effects of anesthetic adjuvant drugs on POCD in elderly patients undergoing noncardiac surgery remains controversial. Methods The final search took place on June 10, 2023. Randomized c...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Brain and Behavior |
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| Online Access: | https://doi.org/10.1002/brb3.3149 |
| _version_ | 1797359481626034176 |
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| author | Lichi Xu Shuxiang Xu Yuelun Zhang Yuguang Huang |
| author_facet | Lichi Xu Shuxiang Xu Yuelun Zhang Yuguang Huang |
| author_sort | Lichi Xu |
| collection | DOAJ |
| description | Abstract Background Elderly patients are prone to postoperative cognitive dysfunction (POCD). The comparison of the effects of anesthetic adjuvant drugs on POCD in elderly patients undergoing noncardiac surgery remains controversial. Methods The final search took place on June 10, 2023. Randomized controlled trials including ketamine, ulinastatin, dexmedetomidine, parecoxib, and midazolam on the prevention and treatment of POCD in elderly undergoing noncardiac surgery were collected. A Bayesian network meta‐analysis was performed to quantitatively combine the evidence. Results A total of 35 randomized trials were finally included in this systematic review, and the overall risk of bias is Allocation concealment. These anesthetic adjuvant drugs did not show significant differences in preventing POCD on postoperative days 1 and 7 compared with each other, but ulinastatin may be more effective in preventing POCD than dexmedetomidine [odds ratio (OR) = 0.28, 95% confidence interval (CI) = (0.10, 0.71)] and parecoxib [OR = 0.3, 95% CI = (0.10, 0.82 on postoperative day 3. The efficiency ranking results also find that ulinastatin and ketamine might provide better effects regarding POCD prevention. Conclusions Ketamine and ulinastatin might have better effects in preventing POCD in elderly patients undergoing noncardiac surgery. Our meta‐analysis provided evidence for the use of ulinastatin and ketamine in the prevention of POCD in elderly patients undergoing noncardiac surgery. |
| first_indexed | 2024-03-08T15:25:28Z |
| format | Article |
| id | doaj.art-565670e21e7c4b518009a9e1850ff570 |
| institution | Directory Open Access Journal |
| issn | 2162-3279 |
| language | English |
| last_indexed | 2024-03-08T15:25:28Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Brain and Behavior |
| spelling | doaj.art-565670e21e7c4b518009a9e1850ff5702024-01-10T10:25:35ZengWileyBrain and Behavior2162-32792023-08-01138n/an/a10.1002/brb3.3149Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysisLichi Xu0Shuxiang Xu1Yuelun Zhang2Yuguang Huang3Department of Anesthesiology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College BeijingP. R. ChinaDepartment of Pain Management Shandong Provincial Hospital, Shandong University JinanShandongP. R. ChinaMedical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College BeijingP. R. ChinaDepartment of Anesthesiology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College BeijingP. R. ChinaAbstract Background Elderly patients are prone to postoperative cognitive dysfunction (POCD). The comparison of the effects of anesthetic adjuvant drugs on POCD in elderly patients undergoing noncardiac surgery remains controversial. Methods The final search took place on June 10, 2023. Randomized controlled trials including ketamine, ulinastatin, dexmedetomidine, parecoxib, and midazolam on the prevention and treatment of POCD in elderly undergoing noncardiac surgery were collected. A Bayesian network meta‐analysis was performed to quantitatively combine the evidence. Results A total of 35 randomized trials were finally included in this systematic review, and the overall risk of bias is Allocation concealment. These anesthetic adjuvant drugs did not show significant differences in preventing POCD on postoperative days 1 and 7 compared with each other, but ulinastatin may be more effective in preventing POCD than dexmedetomidine [odds ratio (OR) = 0.28, 95% confidence interval (CI) = (0.10, 0.71)] and parecoxib [OR = 0.3, 95% CI = (0.10, 0.82 on postoperative day 3. The efficiency ranking results also find that ulinastatin and ketamine might provide better effects regarding POCD prevention. Conclusions Ketamine and ulinastatin might have better effects in preventing POCD in elderly patients undergoing noncardiac surgery. Our meta‐analysis provided evidence for the use of ulinastatin and ketamine in the prevention of POCD in elderly patients undergoing noncardiac surgery.https://doi.org/10.1002/brb3.3149anesthetic adjunctive agentsBayesian network meta‐analysiselderly patientspostoperative cognitive dysfunction (POCD) |
| spellingShingle | Lichi Xu Shuxiang Xu Yuelun Zhang Yuguang Huang Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis Brain and Behavior anesthetic adjunctive agents Bayesian network meta‐analysis elderly patients postoperative cognitive dysfunction (POCD) |
| title | Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis |
| title_full | Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis |
| title_fullStr | Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis |
| title_full_unstemmed | Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis |
| title_short | Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta‐analysis |
| title_sort | effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery a bayesian network meta analysis |
| topic | anesthetic adjunctive agents Bayesian network meta‐analysis elderly patients postoperative cognitive dysfunction (POCD) |
| url | https://doi.org/10.1002/brb3.3149 |
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