Analysis of postoperative cognitive dysfunction and influencing factors of dexmedetomidine anesthesia in elderly patients with colorectal cancer

Zhang,Jingchao; Liu,Guoqing; Zhang,Fangxiang; Fang,Hua; Zhang,Duwen; Liu,Shuchun; Chen,Bingning; Xiao,Hong

doi:10.3892/ol.2019.10611

Analysis of postoperative cognitive dysfunction and influencing factors of dexmedetomidine anesthesia in elderly patients with colorectal cancer

Authors:
- Jingchao Zhang
- Guoqing Liu
- Fangxiang Zhang
- Hua Fang
- Duwen Zhang
- Shuchun Liu
- Bingning Chen
- Hong Xiao
View Affiliations

Affiliations: Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China, Department of Anesthesiology, Jinan Zhangqiu District Hospital of TCM, Jinan, Shandong 250200, P.R. China, Department of Anesthesiology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361001, P.R. China
Published online on: July 12, 2019 https://doi.org/10.3892/ol.2019.10611
Pages: 3058-3064
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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

Effect of dexmedetomidine-assisted general anesthesia on early postoperative cognitive dysfunctions in elderly patients with colorectal cancer was explored. In total, 140 patients with radical colorectal cancer under general anesthesia from March 2012 to June 2015 were enrolled in the Guizhou Provincial People's Hospital, including 80 patients in the dexmedetomidine group and 60 patients in the saline group. Surgery conditions were recorded, and the incidence of postoperative cognitive dysfunction (POCD) and cognitive function score (MMSE score) were compared between the two groups. Serum levels of S-100β protein (S-100β) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay. The anesthesia time and intraoperative blood loss in the experiment group were significantly lower than those in the control group (P<0.05). The MMSE scores of the two groups on the 1st and 3rd day after surgery were lower than those before surgery (P<0.05). The incidence rates of the experiment group were significantly lower than that of the control group (P<0.05). The levels of serum IL-6 and S-100β were increased on the 1st and 3rd day after surgery compared with those before surgery (P<0.05). The levels of serum IL-6 and S-100β in the control group were significantly higher than those in the experiment group on the 1st and 3rd day after surgery (P<0.05). Age, duration of anesthesia, intraoperative blood loss, expression of IL-6 and S-100β were the influencing factors of POCD. Age ≥70 years, anesthesia duration ≥3 h, intraoperative blood loss ≥350 ml, and high expression of IL-6 and S-100β was an important factor related to the occurrence (P<0.05). Dexmedetomidine can significantly improve postoperative cognitive dysfunction in elderly patients with colorectal cancer, and the occurrence of cognitive dysfunction can be affected by age, duration of anesthesia, intraoperative blood loss and the high expression of IL-6 and S-100β.

View Figures

View References

1	Vincent MD, Breadner D, Cripps MC, Jonker DJ, Klimo P, Biagi JJ, Lam W, O'Connell A, Whiston F, Stitt L, et al: Phase I/II trial of dose-reduced capecitabine in elderly patients with advanced colorectal cancer. Curr Oncol. 24:e261–e268. 2017. View Article : Google Scholar : PubMed/NCBI
2	Finlayson E, Zhao S and Varma MG: Outcomes after rectal cancer surgery in elderly nursing home residents. Dis Colon Rectum. 55:1229–1235. 2012. View Article : Google Scholar : PubMed/NCBI
3	Kennedy RH, Francis EA, Wharton R, Blazeby JM, Quirke P, West NP and Dutton SJ: Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol. 32:1804–1811. 2014. View Article : Google Scholar : PubMed/NCBI
4	Shen F, Cai WS, Li JL, Feng Z, Liu QC, Xiao HQ, Cao J and Xu B: Synergism from the combination of ulinastatin and curcumin offers greater inhibition against colorectal cancer liver metastases via modulating matrix metalloproteinase-9 and E-cadherin expression. Onco Targets Ther. 7:305–314. 2014.PubMed/NCBI
5	Feinkohl I, Winterer G, Spies CD and Pischon T: Cognitive reserve and the risk of postoperative cognitive dysfunction. Dtsch Arztebl Int. 114:110–117. 2017.PubMed/NCBI
6	Visovatti MA, Reuter-Lorenz PA, Chang AE, Northouse L and Cimprich B: Assessment of cognitive impairment and complaints in individuals with colorectal cancer. Oncol Nurs Forum. 43:169–178. 2016. View Article : Google Scholar : PubMed/NCBI
7	Louzon P, Jennings H, Ali M and Kraisinger M: Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds. Am J Health Syst Pharm. 74:253–262. 2017. View Article : Google Scholar : PubMed/NCBI
8	Tasdogan M, Memis D, Sut N and Yuksel M: Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J Clin Anesth. 21:394–400. 2009. View Article : Google Scholar : PubMed/NCBI
9	Xiong B, Shi Q and Fang H: Dexmedetomidine alleviates postoperative cognitive dysfunction by inhibiting neuron excitation in aged rats. Am J Transl Res. 8:70–80. 2016.PubMed/NCBI
10	Fu C, Dai X, Yang Y, Lin M, Cai Y and Cai S: Dexmedetomidine attenuates lipopolysaccharide-induced acute lung injury by inhibiting oxidative stress, mitochondrial dysfunction and apoptosis in rats. Mol Med Rep. 15:131–138. 2017. View Article : Google Scholar : PubMed/NCBI
11	Dufouil C, Clayton D, Brayne C, Chi LY, Dening TR, Paykel ES, O'Connor DW, Ahmed A, McGee MA and Huppert FA: Population norms for the MMSE in the very old: Estimates based on longitudinal data. Mini-Mental State Examination. Neurology. 55:1609–1613. 2000. View Article : Google Scholar : PubMed/NCBI
12	Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ and He J: Cancer statistics in China, 2015. CA Cancer J Clin. 66:115–132. 2016. View Article : Google Scholar : PubMed/NCBI
13	Allemani C, Rachet B, Weir HK, Richardson LC, Lepage C, Faivre J, Gatta G, Capocaccia R, Sant M, Baili P, et al: Colorectal cancer survival in the USA and Europe: A CONCORD high-resolution study. BMJ Open. 3:e0030552013. View Article : Google Scholar : PubMed/NCBI
14	Citronberg J, Bostick R, Ahearn T, Turgeon DK, Ruffin MT, Djuric Z, Sen A, Brenner DE and Zick SM: Effects of ginger supplementation on cell-cycle biomarkers in the normal-appearing colonic mucosa of patients at increased risk for colorectal cancer: Results from a pilot, randomized, and controlled trial. Cancer Prev Res (Phila). 6:271–281. 2013. View Article : Google Scholar : PubMed/NCBI
15	Galsky MD, Stensland KD, Moshier E, Sfakianos JP, McBride RB, Tsao CK, Casey M, Boffetta P, Oh WK, Mazumdar M, et al: Effectiveness of adjuvant chemotherapy for locally advanced bladder cancer. J Clin Oncol. 34:825–832. 2016. View Article : Google Scholar : PubMed/NCBI
16	Güçlü CY, Ünver S, Aydınlı B, Kazancı D, Dilber E and Özgök A: The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during cardiopulmonary bypass - randomized trial. Adv Clin Exp Med. 23:919–924. 2014. View Article : Google Scholar : PubMed/NCBI
17	de Tournay-Jetté E, Dupuis G, Bherer L, Deschamps A, Cartier R and Denault A: The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 25:95–104. 2011. View Article : Google Scholar : PubMed/NCBI
18	Gruppo AIR: Consensus document: a model of integrated management of patients with psycomotor agitation. Riv Psichiatr. 51:238–250. 2016.(In Italian). PubMed/NCBI
19	Zhang J, Zhang J, Yu P, Chen M, Peng Q, Wang Z and Dong N: Remote ischaemic preconditioning and sevoflurane postconditioning synergistically protect rats from myocardial injury induced by ischemia and reperfusion partly via inhibition TLR4/MyD88/NF-κB signaling pathway. Cell Physiol Biochem. 41:22–32. 2017. View Article : Google Scholar : PubMed/NCBI
20	Ohtani N, Kida K, Shoji K, Yasui Y and Masaki E: Recovery profiles from dexmedetomidine as a general anesthetic adjuvant in patients undergoing lower abdominal surgery. Anesth Analg. 107:1871–1874. 2008. View Article : Google Scholar : PubMed/NCBI
21	Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A and Otelcioglu S: Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: Perioperative haemodynamics and anaesthetic requirements. Drugs R D. 7:43–52. 2006. View Article : Google Scholar : PubMed/NCBI
22	Pavlov VA and Tracey KJ: The cholinergic anti-inflammatory pathway. Brain Behav Immun. 19:493–499. 2005. View Article : Google Scholar : PubMed/NCBI
23	Teegarden BM and Prough DS: Delirium: Getting back on track. Crit Care Med. 44:1265–1266. 2016. View Article : Google Scholar : PubMed/NCBI
24	Li QY, Xu HY and Yang HJ: Effect of proinflammatory factors TNF-α, IL-1β, IL-6 on neuropathic pain. Zhongguo Zhong Yao Za Zhi. 42:3709–3712. 2017.(In Chinese). PubMed/NCBI
25	Yang B, Qian F, Li W, Li Y and Han Y: Effects of general anesthesia with or without epidural block on tumor metastasis and mechanisms. Oncol Lett. 15:4662–4668. 2018.PubMed/NCBI
26	Liu F, Zhang J, Zeng XQ, Zhao YQ and Zuo YX: Application of general anesthesia combined with epidural anesthesia/analgesia in rehabilitation after gastric cancer resection. Zhonghua Yi Xue Za Zhi. 97:1089–1092. 2017.(In Chinese). PubMed/NCBI
27	van Harten AE, Scheeren TW and Absalom AR: A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia. 67:280–293. 2012. View Article : Google Scholar : PubMed/NCBI
28	Chan MT, Cheng BC, Lee TM and Gin T; CODA Trial Group, : BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 25:33–42. 2013. View Article : Google Scholar : PubMed/NCBI
29	Barrientos RM, Hein AM, Frank MG, Watkins LR and Maier SF: Intracisternal interleukin-1 receptor antagonist prevents postoperative cognitive decline and neuroinflammatory response in aged rats. J Neurosci. 32:14641–14648. 2012. View Article : Google Scholar : PubMed/NCBI
30	Wu C, Wang R, Li X and Chen J: Preoperative serum microRNA-155 expression independently predicts postoperative cognitive dysfunction after laparoscopic surgery for colon cancer. Med Sci Monit. 22:4503–4508. 2016. View Article : Google Scholar : PubMed/NCBI
31	Wang XT, Lv M and Guo HY: Effects of epidural block combined with general anesthesia on antitumor characteristics of T helper cells in hepatocellular carcinoma patients. J Biol Regul Homeost Agents. 30:67–77. 2016.PubMed/NCBI
32	Hanning CD: Postoperative cognitive dysfunction. Br J Anaesth. 95:82–87. 2005. View Article : Google Scholar : PubMed/NCBI
33	Ramlawi B, Rudolph JL, Mieno S, Feng J, Boodhwani M, Khabbaz K, Levkoff SE, Marcantonio ER, Bianchi C and Sellke FW: C-Reactive protein and inflammatory response associated to neurocognitive decline following cardiac surgery. Surgery. 140:221–226. 2006. View Article : Google Scholar : PubMed/NCBI
34	Fu M and Li D: General anesthesia combined with epidural anesthesia on the postoperative cognitive functions in pregnant women with dystocia. Exp Ther Med. 16:1149–1152. 2018.PubMed/NCBI