Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients

Chen,Jingjun; Yan,Junqiang; Han,Xueping

doi:10.3892/etm.2012.811

Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients

Authors:
- Jingjun Chen
- Junqiang Yan
- Xueping Han
View Affiliations

Affiliations: Department of Anesthesiology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P.R. China, Department of Neurology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P.R. China, Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
Published online on: November 13, 2012 https://doi.org/10.3892/etm.2012.811
Pages: 489-494

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Laparoscopic cholecystectomy is performed with increasing frequency in aging populations. However, in elderly patients, cognitive dysfunction following surgery may impair the outcome of surgical procedures. Dexmedetomidine (DEX) has been demonstrated to have a neuroprotectve effect in animal experiments. However, it is unclear whether DEX also has a neuroprotective effect in human patients. The present study was a randomized, placebo-controlled double-blind trial of 126 patients who had undergone laparoscopic cholecystectomy, using clinical interviews to determine whether intravenously administrated DEX during general anesthesia ameliorates cognitive function impairment. The cognitive deficit of each patient was assessed using the Mini‑Mental State Examination (MMSE). The scores on the MMSE for the DEX and control groups one week after surgery (DEX group, 27.6±1.2; control group, 25.7±1.5) were significantly different (P=0.005). The MMSE scores of patients ≤65 years old were significantly higher than those of patients >65 one week after surgery. The MMSE scores were significantly different between the two age groups in the control patients (≤65 years old, 28.3±1.2; >65 years old, 26.6±2.1; P=0.036), while the difference was not statistically significant in the DEX-treated patients. Eight patients in the DEX group and 15 patients in the control group had mild cognitive impairment (26≥ MMSE score ≥21) although the difference was not statistically significant. The findings of the present study support the hypothesis that DEX administration may be an effective method for ameliorating postoperative cognitive impairment in elderly patients who have undergone laparoscopic cholecystectomy. Further research is required to confirm the findings of the present study.

View Figures

View References

1.	Price CC, Garvan CW and Monk TG: Type and severity of cognitive decline in older adults after noncardiac surgery. Anesthesiology. 108:8–17. 2008. View Article : Google Scholar : PubMed/NCBI
2.	Bedford PD: Adverse cerebral effects of anaesthesia on old people. Lancet. 269:259–263. 1955. View Article : Google Scholar : PubMed/NCBI
3.	Monk TG, Weldon BC, Garvan CW, et al: Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 108:18–30. 2008. View Article : Google Scholar : PubMed/NCBI
4.	Rasmussen LS: Postoperative cognitive dysfunction: incidence and prevention. Best Pract Res Clin Anaesthesiol. 20:315–330. 2006. View Article : Google Scholar : PubMed/NCBI
5.	Zurek AA, Bridgwater EM and Orser BA: Inhibition of α5 γ-aminobutyric acid type A receptors restores recognition memory after general anesthesia. Anesth Analg. 114:845–855. 2012.
6.	Callaway JK, Jones NC and Royse CF: Isoflurane induces cognitive deficits in the Morris water maze task in rats. Eur J Anaesthesiol. 29:239–245. 2012. View Article : Google Scholar : PubMed/NCBI
7.	Le Freche H, Brouillette J, Fernandez-Gomez FJ, et al: Tau phosphorylation and sevoflurane anesthesia: an association to postoperative cognitive impairment. Anesthesiology. 116:779–787. 2012.PubMed/NCBI
8.	Krenk L, Rasmussen LS, Hansen TB, Bog S, Søballe K and Kehlet H: Delirium after fast-track hip and knee arthroplasty. Br J Anaesth. 108:607–611. 2012. View Article : Google Scholar : PubMed/NCBI
9.	Kavanagh T and Buggy DJ: Can anaesthetic technique effect postoperative outcome? Curr Opin Anaesthesiol. 25:185–198. 2012. View Article : Google Scholar : PubMed/NCBI
10.	Denis R, Letourneau JE and Londorf D: Reliability and validity of psychomotor tests as measures of recovery from isoflurane or enflurane anesthesia in a day-care surgery unit. Anesth Analg. 63:653–656. 1984. View Article : Google Scholar : PubMed/NCBI
11.	Tzabar Y, Asbury AJ and Millar K: Cognitive failures after general anaesthesia for day-case surgery. Br J Anaesth. 76:194–197. 1996. View Article : Google Scholar : PubMed/NCBI
12.	Williams-Russo P, Sharrock NE, Mattis S, Szatrowski TP and Charlson ME: Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA. 274:44–50. 1995. View Article : Google Scholar : PubMed/NCBI
13.	Rasmussen LS, Johnson T, Kuipers HM, et al: Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 47:260–266. 2003. View Article : Google Scholar
14.	Bhana N, Goa KL and McClellan KJ: Dexmedetomidine. Drugs. 59:263–268; discussion. 269–270. 2000. View Article : Google Scholar : PubMed/NCBI
15.	Guler G, Akin A, Tosun Z, Eskitascoglu E, Mizrak A and Boyaci A: Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand. 49:1088–1091. 2005. View Article : Google Scholar : PubMed/NCBI
16.	Khan ZP, Munday IT, Jones RM, Thornton C, Mant TG and Amin D: Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1: Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth. 83:372–380. 1999. View Article : Google Scholar : PubMed/NCBI
17.	Jaakola ML, Salonen M, Lehtinen R and Scheinin H: The analgesic action of dexmedetomidine - a novel alpha 2-adrenoceptor agonist - in healthy volunteers. Pain. 46:281–285. 1991. View Article : Google Scholar : PubMed/NCBI
18.	Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W and Bekker AY; MAC Study Group: Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Anesth Analg. 110:47–56. 2010. View Article : Google Scholar : PubMed/NCBI
19.	Cooper L, Candiotti K, Gallagher C, Grenier E, Arheart KL and Barron ME: A randomized, controlled trial on dexmedetomidine for providing adequate sedation and hemodynamic control for awake, diagnostic transesophageal echocardiography. J Cardiothorac Vasc Anesth. 25:233–237. 2011. View Article : Google Scholar
20.	Xu Y, Yan J, Zhou P, et al: Neurotransmitter receptors and cognitive dysfunction in Alzheimer’s disease and Parkinson’s disease. Prog Neurobiol. 97:1–13. 2012.
21.	Coull JT: Pharmacological manipulations of the alpha 2-noradrenergic system. Effects on cognition. Drugs Aging. 5:116–126. 1994. View Article : Google Scholar : PubMed/NCBI
22.	Milstein JA, Lehmann O, Theobald DE, Dalley JW and Robbins TW: Selective depletion of cortical noradrenaline by anti-dopamine beta-hydroxylase-saporin impairs attentional function and enhances the effects of guanfacine in the rat. Psychopharmacology (Berl). 190:51–63. 2007. View Article : Google Scholar : PubMed/NCBI
23.	Galeotti N, Bartolini A and Ghelardini C: Alpha-2 agonist-induced memory impairment is mediated by the alpha-2A-adrenoceptor subtype. Behav Brain Res. 153:409–417. 2004. View Article : Google Scholar : PubMed/NCBI
24.	Folstein MF, Folstein SE and McHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 12:189–198. 1975.
25.	Rasmussen LS; ISPOCD2 Investigators: Post-operative cognitive dysfunction in the elderly. Acta Anaesthesiol Scand. 49:15732005. View Article : Google Scholar : PubMed/NCBI
26.	Rasmussen LS and Siersma VD; ISPOCD Group: Postoperative cognitive dysfunction: true deterioration versus random variation. Acta Anaesthesiol Scand. 48:1137–1143. 2004. View Article : Google Scholar : PubMed/NCBI
27.	Ancelin ML, de Roquefeuil G, Scali J, et al: Long-term post-operative cognitive decline in the elderly: the effects of anesthesia type, apolipoprotein E genotype, and clinical antecedents. J Alzheimers Dis. 22(Suppl 3): 105–113. 2010.PubMed/NCBI
28.	Jin F and Chung F: Minimizing perioperative adverse events in the elderly. Br J Anaesth. 87:608–624. 2001. View Article : Google Scholar : PubMed/NCBI
29.	Ehara T, Ogawa Y, Kato J, Aoki K, Ogawa S and Iwasaki K: The effect of dexmedetomidine on arterial-cardiac baroreflex function assessed by spectral and transfer function analysis. J Anesth. 26:483–489. 2012. View Article : Google Scholar : PubMed/NCBI
30.	Dodds TM, Stone JG, Coromilas J, Weinberger M and Levy DG: Prophylactic nitroglycerin infusion during noncardiac surgery does not reduce perioperative ischemia. Anesth Analg. 76:705–713. 1993. View Article : Google Scholar : PubMed/NCBI
31.	Iirola T, Vilo S, Manner T, et al: Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 67:825–831. 2011. View Article : Google Scholar : PubMed/NCBI
32.	Honkavaara JM, Restitutti F, Raekallio MR, Kuusela EK and Vainio OM: The effects of increasing doses of MK-467, a peripheral alpha(2)-adrenergic receptor antagonist, on the cardiopulmonary effects of intravenous dexmedetomidine in conscious dogs. J Vet Pharmacol Ther. 34:332–337. 2011. View Article : Google Scholar
33.	Khan ZP, Ferguson CN and Jones RM: alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 54:146–165. 1999. View Article : Google Scholar : PubMed/NCBI
34.	Martin E, Ramsay G, Mantz J and Sum-Ping ST: The role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med. 18:29–41. 2003. View Article : Google Scholar : PubMed/NCBI
35.	Ben-Abraham R, Ogorek D and Weinbroum AA: Dexmedetomidine: a promising agent for anesthesia and perioperative care. Isr Med Assoc J. 2:793–796. 2000.PubMed/NCBI
36.	Lawrence CJ and De Lange S: Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia. 52:736–744. 1997. View Article : Google Scholar : PubMed/NCBI
37.	Lawrence CJ, Prinzen FW and de Lange S: Hemodynamic and coronary vascular effects of dexmedetomidine in the anesthetized goat. Acta Anaesthesiol Scand. 41:830–836. 1997. View Article : Google Scholar : PubMed/NCBI
38.	Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A and Otelcioglu S: Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation : perioperative haemo-dynamics and anaesthetic requirements. Drugs R D. 7:43–52. 2006. View Article : Google Scholar : PubMed/NCBI
39.	Kang WS, Kim SY, Son JC, et al: The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol. 62:113–118. 2012. View Article : Google Scholar
40.	Sato K, Kimura T, Nishikawa T, Tobe Y and Masaki Y: Neuroprotective effects of a combination of dexmedetomidine and hypothermia after incomplete cerebral ischemia in rats. Acta Anaesthesiol Scand. 54:377–382. 2010. View Article : Google Scholar : PubMed/NCBI
41.	Sanders RD, Xu J, Shu Y, et al: Dexmedetomidine attenuates isoflurane-induced neurocognitive impairment in neonatal rats. Anesthesiology. 110:1077–1085. 2009. View Article : Google Scholar : PubMed/NCBI
42.	Goyagi T, Nishikawa T, Tobe Y and Masaki Y: The combined neuroprotective effects of lidocaine and dexmedetomidine after transient forebrain ischemia in rats. Acta Anaesthesiol Scand. 53:1176–1183. 2009. View Article : Google Scholar : PubMed/NCBI
43.	Kuhmonen J, Haapalinna A and Sivenius J: Effects of dexmedetomidine after transient and permanent occlusion of the middle cerebral artery in the rat. J Neural Transm. 108:261–271. 2001. View Article : Google Scholar : PubMed/NCBI
44.	Kuhmonen J, Pokorný J, Miettinen R, et al: Neuroprotective effects of dexmedetomidine in the gerbil hippocampus after transient global ischemia. Anesthesiology. 87:371–377. 1997. View Article : Google Scholar : PubMed/NCBI
45.	Moller JT, Cluitmans P, Rasmussen LS, et al: Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators International Study of Post-Operative Cognitive Dysfunction. Lancet. 351:857–861. 1998. View Article : Google Scholar
46.	Rasmussen LS, Steentoft A, Rasmussen H, Kristensen PA and Moller JT: Benzodiazepines and postoperative cognitive dysfunction in the elderly. ISPOCD Group. International Study of Postoperative Cognitive Dysfunction. Br J Anaesth. 83:585–589. 1999. View Article : Google Scholar : PubMed/NCBI