Effects of dexmedetomidine combined with etomidate on postoperative cognitive function in older patients undergoing total intravenous anaesthesia: a randomized, double-blind, controlled trial.

BACKGROUND

Etomidate has been advocated for anesthesia in older and critically ill patients because of its hemodynamic stability. Clinical studies have shown that dexmedetomidine has neuroprotective and anti-inflammatory properties and improves postoperative cognitive dysfunction in older patients. The present study was to evaluate the effects of the combination of etomidate and dexmedetomidine with different anaesthesia time on postoperative cognitive function in older patients.

METHODS

A total of 132 older patients undergoing ureteroscopic holmium laser lithotripsy were randomly divided into EN group and ED group equally. Patients whose surgery time was less than or equal to 1 h in each group were allocated to short-time surgery group (EN group and ED group), and whose surgery time was more than 1h were allocated to long-term surgery group (EN group and ED group). The primary outcome was the score of the Mini-Mental State Examination. The secondary outcomes were State-Trait Anxiety Inventory scores, Riker sedation agitation scores, Zung Self-Rating Depression Scale scores, the memory span for Arabic numerals, the plasma concentrations of S-100 calcium-binding protein B and neuron specific enolase, the time to spontaneous respiration, recovery, and extubation.

RESULTS

The MMSE scores at t were higher in ED and ED groups than in EN and EN groups (p<0.05). Compared with ED and ED groups, the ZSDS scores, the S-AI scores and the T-AI scores at t were higher in EN and EN groups (p<0.05), respectively. The recalled Arabic numbers at t were higher in ED group than in EN group (p<0.05). The plasma concentration of S-100β at t in EN group and t in EN group were higher than that in ED and ED groups (p<0.05), respectively. Compared with ED and ED groups, the plasma concentrations of NSE were higher at t in EN group and t in EN group (p<0.05), respectively.

CONCLUSION

The administration of dexmedetomidine could improve postoperative cognitive dysfunction, emergence agitation, depression and anxiety, attenuate the plasma concentrations of S-100β and NSE in older patients undergoing total intravenous anaesthesia with etomidate.

TRIAL REGISTRATION

Registration number: ChiCTR1800015421, Date: 29/03/2018.