Effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures_West China Medical Journal

Authors：

 LI Qing

Department of Anesthesiology, the First People’s Hospital of Ziyang, Ziyang, Sichuan 641300, P. R. China;

Corresponding author：

LI Qing, Email: 3235710237@qq.com

Keywords：

Dexmedetomidine; Ketamine; Femoral neck fractures; Postoperative cognitive dysfunction

DOI：

10.7507/1002-0179.201608151

Video：

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Objective To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures. Methods A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected. Results There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05). Conclusion For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.

Citation： LI Qing. Effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures. West China Medical Journal, 2017, 32(8): 1212-1216. doi: 10.7507/1002-0179.201608151 Copy

1.	Zhang Q, Cheng CK, Wei HW, et al. Biomechanical comparisons between a new avascular necrosis of femaral head stem based on Chinese patients with avascular necrosis and two other designs. Chin Med J (Engl), 2013, 126(10): 1918-1924.
2.	Laalou FZ, Jochum D, Pain L. Postoperative cognitive dysfunction (POCD): strategy of prevention, assessment and management. Ann Fr Anesth Reanim, 2011, 30(10): e49-e53.
3.	Liebert AD, Chow RT, Bicknell BT, et al. Neuroprotective effects against POCD by photobiomodulation: evidence from assembly/disassembly of the cytoskeleton. J Exp Neurosci, 2016, 10: 1-19.
4.	Ding LL, Zhang H, Mi WD, et al. Effects of dexmedetomidine on anesthesia recovery period and postoperative cognitive function of patients after robot-assisted laparoscopic radical cystectomy. Int J Clin Exp Med, 2015, 8(7): 11388-11395.
5.	Wu Y, Wang J, Wu A, et al. Do fluctuations in endogenous melatonin levels predict the occurrence of postoperative cognitive dysfunction (POCD)? Int J Neurosci, 2014, 124(11): 787-791.
6.	Peng L, Xu L, Ouyang W. Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis. PLoS One, 2013, 8(11): e79624.
7.	Derakhshan I. Disparity of neural and behavioral handedness in evaluating candidates for POCD. Perfusion, 2013, 28(5): 459-460.
8.	Al-Badawi IA, Alomar O, Albadawi N, et al. Single-port laparoscopic surgery for benign salpingo-ovarian pathology: a single-center experience from Saudi Arabia. Ann Saudi Med, 2016, 36(1): 64-69.
9.	Laalou FZ, Carre AC, Forestier C, et al. Pathophysiology of post-operative cognitive dysfunction: current hypotheses. J Chir (Paris), 2008, 145(4): 323-330.
10.	Rappold T, Laflam A, Hori D, et al. Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery. Br J Anaesth, 2016, 116(1): 83-89.
11.	Franck M, Nerlich K, Neuner B, et al. No convincing association between post-operative delirium and post-operative cognitive dysfunction: a secondary analysis. Acta Anaesthesiol Scand, 2016, 60(10): 1404-1414.
12.	Arora S, Goel N, Aggarwal P, et al. Salvage of proximal tibia fracture treated with locked compression plate. J Clin Orthop Trauma, 2012, 3(1): 58-61.
13.	Song Z, Fu P, Chen M, et al. Association of CT perfusion and postoperative cognitive dysfunction after off-pump coronary artery bypass grafting. Neurol Res, 2016, 38(6): 533-537.
14.	Lee KH, Kim JY, Kim JW, et al. Influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients. Anesth pain med, 2015, 5(5): e28844.
15.	Bilotta F, Gelb AW, Stazi E, et al. Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials. Br J Anaesth, 2013, 110(Suppl 1): i113-i120.
16.	Hudetz JA, Iqbal Z, Gandhi SD, et al. Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery. Acta Anaesthesiol Scand, 2009, 53(7): 864-872.
17.	Li YH, He R, Chen SF, et al. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp Ther Med, 2015, 10(5): 1635-1642.
18.	Ohno Y, Yamada S, Sugiura T, et al. Possible role of NF-ĸB signals in heat stress-associated increase in protein content of cultured C2C12 cells. Cells Tissues Organs, 2011, 194(5): 363-370.

1. Zhang Q, Cheng CK, Wei HW, et al. Biomechanical comparisons between a new avascular necrosis of femaral head stem based on Chinese patients with avascular necrosis and two other designs. Chin Med J (Engl), 2013, 126(10): 1918-1924.
2. Laalou FZ, Jochum D, Pain L. Postoperative cognitive dysfunction (POCD): strategy of prevention, assessment and management. Ann Fr Anesth Reanim, 2011, 30(10): e49-e53.
3. Liebert AD, Chow RT, Bicknell BT, et al. Neuroprotective effects against POCD by photobiomodulation: evidence from assembly/disassembly of the cytoskeleton. J Exp Neurosci, 2016, 10: 1-19.
4. Ding LL, Zhang H, Mi WD, et al. Effects of dexmedetomidine on anesthesia recovery period and postoperative cognitive function of patients after robot-assisted laparoscopic radical cystectomy. Int J Clin Exp Med, 2015, 8(7): 11388-11395.
5. Wu Y, Wang J, Wu A, et al. Do fluctuations in endogenous melatonin levels predict the occurrence of postoperative cognitive dysfunction (POCD)? Int J Neurosci, 2014, 124(11): 787-791.
6. Peng L, Xu L, Ouyang W. Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis. PLoS One, 2013, 8(11): e79624.
7. Derakhshan I. Disparity of neural and behavioral handedness in evaluating candidates for POCD. Perfusion, 2013, 28(5): 459-460.
8. Al-Badawi IA, Alomar O, Albadawi N, et al. Single-port laparoscopic surgery for benign salpingo-ovarian pathology: a single-center experience from Saudi Arabia. Ann Saudi Med, 2016, 36(1): 64-69.
9. Laalou FZ, Carre AC, Forestier C, et al. Pathophysiology of post-operative cognitive dysfunction: current hypotheses. J Chir (Paris), 2008, 145(4): 323-330.
10. Rappold T, Laflam A, Hori D, et al. Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery. Br J Anaesth, 2016, 116(1): 83-89.
11. Franck M, Nerlich K, Neuner B, et al. No convincing association between post-operative delirium and post-operative cognitive dysfunction: a secondary analysis. Acta Anaesthesiol Scand, 2016, 60(10): 1404-1414.
12. Arora S, Goel N, Aggarwal P, et al. Salvage of proximal tibia fracture treated with locked compression plate. J Clin Orthop Trauma, 2012, 3(1): 58-61.
13. Song Z, Fu P, Chen M, et al. Association of CT perfusion and postoperative cognitive dysfunction after off-pump coronary artery bypass grafting. Neurol Res, 2016, 38(6): 533-537.
14. Lee KH, Kim JY, Kim JW, et al. Influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients. Anesth pain med, 2015, 5(5): e28844.
15. Bilotta F, Gelb AW, Stazi E, et al. Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials. Br J Anaesth, 2013, 110(Suppl 1): i113-i120.
16. Hudetz JA, Iqbal Z, Gandhi SD, et al. Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery. Acta Anaesthesiol Scand, 2009, 53(7): 864-872.
17. Li YH, He R, Chen SF, et al. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp Ther Med, 2015, 10(5): 1635-1642.
18. Ohno Y, Yamada S, Sugiura T, et al. Possible role of NF-ĸB signals in heat stress-associated increase in protein content of cultured C2C12 cells. Cells Tissues Organs, 2011, 194(5): 363-370.

West China Medical Journal

Effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures

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