Effect of a Single-dose Dexmedetomidine on Postoperative Delirium and Intraoperative Hemodynamic Outcomes in Elderly Hip Surgery; A Randomized Controlled Trial Dexmedetomidine for Postoperative Delirium
Dexmedetomidine for Postoperative Delirium
DOI:
https://doi.org/10.33192/smj.v76i2.266653Keywords:
Elderly, Dexmedetomidine, Delirium;, Postoperative complications, Hip fractures, HemodynamicsAbstract
Objective: Postoperative delirium (POD) is common in elderly patients. The growing evidences suggesting the potential benefits of dexmedetomidine (DEX) infusion in reducing POD. However, the administration of a singledose DEX remains controversial. This study aims to investigate the effect of a single-dose DEX on POD in elderly
patients undergoing hip surgery.
Materials and Methods: This prospective, randomized, double-blinded trial enrolled patients aged over 65 years who underwent hip surgery under spinal anesthesia. Patients were assigned to either the DEX (received intravenous DEX 0.3-0.5 μg/kg after incision), or the normal saline solution (NSS). Delirium assessments were conducted at the post anesthetic care unit (PACU) and at 24, 48 and 72 hours postoperatively using the Confusion Assessment
Method (CAM).
Results: A total of 200 patients were randomized, with 100 in the DEX and 100 in the NSS. The incidence of POD was significantly lower in the DEX compared to the NSS (P < 0.001, RR 0.45, 95%CI: 0.28, 0.73). This difference remained significant at each postoperative assessment time point. There was no significant difference in sedation score and perioperative hemodynamics, except for a slightly lower intraoperative heart rate (P=0.015) and systolic blood pressure (P=0.029) observed at the PACU in the DEX, but these differences were not clinically significant. Additionally, the length of stay after surgery in the DEX was significantly shorter compare to the NSS (P=0.006).
Conclusion: A single-dose dexmedetomidine can reduce the incidence of POD within 72 hours postoperatively in elderly patients undergoing hip surgery without compromising intraoperative hemodynamic stability.
References
Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609-16.
Tay E. Hip fractures in the elderly: operative versus nonoperative management. Singapore Med J. 2016;57(4):178-81.
Saczynski JS, Inouye SK, Kosar CM, Tommet D, Marcantonio ER, Fong T, et al. Cognitive and brain reserve and the risk of postoperative delirium in older patients: analysis of data from a prospective observational study. The Lancet Psychiatry. 2014;1(6):437-43.
Schenning KJ, Deiner SG. Postoperative Delirium in the Geriatric Patient. Anesthesiol Clin. 2015;33(3):505-16.
Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Elseviers M, Bossaert L. A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients. Crit Care. 2008;12(1):R16.
Whitlock EL, Vannucci A, Avidan MS. POSTOPERATIVE DELIRIUM. Minerva Anestesiol. 2011;77(4):448-56.
Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry. 2013;21(12):1190-222.
Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007;19(2):197-214.
Malik A, Quatman C, Phieffer L, Ly T, Khan S. Incidence, risk factors and clinical impact of postoperative delirium following open reduction and internal fixation (ORIF) for hip fractures: an analysis of 7859 patients from the ACS-NSQIP hip fracture procedure targeted database. Eur J Orthop Surg Traumatol. 2019;29(2):435-46.
Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res. 2011;5(2):128-33.
Suenghataiphorn T, Songwisit S, Tornsatitkul S, Somnuke P. An Overview on Postoperative Cognitive Dysfunction; Pathophysiology, Risk Factors, Prevention and Treatment. Siriraj Med J. 2022;74(10):705-13.
Mo Y, Zimmermann AE. Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. Ann Pharmacother. 2013;47(6):869-76.
Li J, Xiong M, Nadavaluru PR, Zuo W, Ye JH, Eloy JD, et al. Dexmedetomidine Attenuates Neurotoxicity Induced by Prenatal Propofol Exposure. J Neurosurg Anesthesiol. 2016;28(1):51-64.
Hu J, Zhu M, Gao Z, Zhao S, Feng X, Chen J, et al. Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia: A double-blind, randomised clinical trial. Eur J Anaesthesiol. 2021;38(Suppl 1):S9-S17.
Lin C, Tu H, Jie Z, Zhou X, Li C. Effect of Dexmedetomidine on Delirium in Elderly Surgical Patients: A Meta-analysis of Randomized Controlled Trials. Ann Pharmacother. 2021;55(5):624-36.
Liu Y, Ma L, Gao M, Guo W, Ma Y. Dexmedetomidine reduces postoperative delirium after joint replacement in elderly patients with mild cognitive impairment. Aging Clin Exp Res. 2016;28(4):729-36.
Yan C, Ti-jun D. Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Delirium in Elderly Patients Undergoing Total Hip Arthroplasty. International Surgery. 2021;105(1-3):328-35.
Hong H, Zhang DZ, Li M, Wang G, Zhu SN, Zhang Y, et al. Impact of dexmedetomidine supplemented analgesia on delirium in patients recovering from orthopedic surgery: A randomized controlled trial. BMC Anesthesiol. 2021;21(1):223.
Li CJ, Wang BJ, Mu DL, Hu J, Guo C, Li XY, et al. Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery. Br J Surg. 2020;107(2):e123-32.
Zeng H, Li Z, He J, Fu W. Dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing noncardiac surgery: A meta-analysis of randomized controlled trials. PLoS One. 2019;14(8):e0218088.
Schulz KF, Altman DG, Moher D, the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8(1):18.
Kurlowicz L, Wallace M. The Mini-Mental State Examination (MMSE). J Gerontol Nurs. 1999;25(5):8-9.
Tanglakmankhong K, Hampstead BM, Ploutz-Snyder RJ, Potempa K. Cognitive screening assessment in Thai older adults: a prospective study of the reliability and validity of the Abbreviated Mental Test. J Health Res. 2022;36(1):99-109.
Marcantonio ER, Ngo LH, O’Connor M, Jones RN, Crane PK, Metzger ED, et al. 3D-CAM: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-defined Delirium. Ann Intern Med. 2014;161(8):554-61.
Miranda F, Arevalo‐Rodriguez I, Díaz G, Gonzalez F, Plana MN, Zamora J, et al. Confusion Assessment Method for the intensive care unit (CAM‐ICU) for the diagnosis of delirium in adults in critical care settings. Cochrane Database Syst Rev. 2018;2018(9):CD013126.
MDCalc [Internet]. [cited 2023 Jun 11]. Richmond Agitation-Sedation Scale (RASS). Available from: https://www.mdcalc.com/calc/1872/richmond-agitation-sedation-scale-rass
Xie S, Xie M. Effect of dexmedetomidine on postoperative delirium in elderly patients undergoing hip fracture surgery. Pak J Pharm Sci. 2018;31(5(Special)):2277-81.
Zhang W, Wang T, Wang G, Yang M, Zhou Y, Yuan Y. Effects of Dexmedetomidine on Postoperative Delirium and Expression of IL-1β, IL-6, and TNF-α in Elderly Patients After Hip Fracture Operation. Front Pharmacol. 2020;11:678.
Ming S, Zhang X, Gong Z, Xie Y, Xie Y. Perioperative dexmedetomidine and postoperative delirium in non-cardiac surgery: a meta-analysis. Ann Palliat Med. 2020;9(2):264-71.
Duan X, Coburn M, Rossaint R, Sanders RD, Waesberghe JV, Kowark A. Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials. Br J Anaesth. 2018;121(2):384-97.
Suwanpasu S, Grinslade S, Wu YWB, Porock D. Risk factors of delirium in elderly patients with hip fracture. Asian Biomedicine. 2014;8(2):157-65.
Yang Y, Zhao X, Dong T, Yang Z, Zhang Q, Zhang Y. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. 2017;29(2):115-26.
Deiner S, Luo X, Lin HM, Sessler DI, Saager L, Sieber FE, et al. Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial. JAMA Surg. 2017;152(8):e171505.
Published
How to Cite
License
Copyright (c) 2024 Siriraj Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Users are free to share, copy, and redistribute all articles published in the Siriraj Medical Journal (SMJ) in any medium or format as long as you follow the following terms:
- Attribution — You must give appropriate credit, provide a link to the material, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the publisher endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
- NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
