Effect of Dexmedetomidine on Postoperative Cognitive Dysfunction of Chinese Patients undergoing Abdominal Surgeries: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 SHIYue , LIYu ,  MAHong

Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China;

Corresponding author：

MAHong, Email: mahong5466@yahoo.com

Keywords：

Abdominal surgery; Dexmedetomidine; Postoperative cognitive dysfunction; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.20150194

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the effect of Dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) of Chinese patients undergoing abdominal surgeries. Methods We searched databases including PubMed, Web of Science, CNKI, CBM, VIP and WanFang Data from inception to April 2015, to collect randomized controlled trials (RCTs) about evaluating the effect of Dex on POCD of Chinese patients undergoing abdominal surgeries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 8 RCTs were included. The results of meta-analysis showed that:compared with the control group, the MMSE scores of the Dex group were higher after surgeries in the first day (MD=1.46, 95%CI 0.98 to 1.95, P<0.000 01), the second day (MD=2.46, 95%CI 2.11 to 2.81, P<0.000 01), the third day (MD=1.81, 95%CI 0.37 to 3.25, P=0.01) and the seventh day (WMD=2.03, 95%CI 1.64 to 2.43, P<0.000 01). Conclusion Current evidence shows that the usage of Dex during abdominal surgeries can reduce the incidence of POCD in Chinese patients. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.

Citation： SHIYue, LIYu, MAHong. Effect of Dexmedetomidine on Postoperative Cognitive Dysfunction of Chinese Patients undergoing Abdominal Surgeries: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(10): 1168-1173. doi: 10.7507/1672-2531.20150194 Copy

1.	Steinmetz J, Christensen KB, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 2009, 110(3):548-555.
2.	Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res, 2011, 5(2):128-133.
3.	Nishizawa T, Suzuki H, Sagara S, et al. Dexmedetomidine versus midazolam for gastrointestinal endoscopy:a meta-analysis. Dig Endosc, 2015, 27(1):8-15.
4.	Lin YY, He B, Chen J, et al. Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis. Crit Care, 2012, 16(5):R169.
5.	Turunen H, Jakob SM, Ruokonen E, et al. Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care:an economic evaluation. Crit Care, 2015, 19(1):67.
6.	Chen K, Lu Z, Xin YC, et al. Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. Cochrane Database Syst Rev, 2015, 1:CD010269.
7.	Bong CL, Lim E, Allen JC, et al. A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging. Anaesthesia, 2015, 70(4):393-399.
8.	Ayeko M, Mohamed AA. Prevention and treatment of sevoflurane emergence agitation and delirium in children with dexmedetomidine. Saudi J Anaesth, 2015, 9(1):103.
9.	Patel A, Davidson M, Tran MC, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Anal, 2010, 111(4):1004-1010.
10.	Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12):1098-1104.
11.	Hanoura SE, Hassanin R, Singh R. Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia. Anesth Essays Res, 2013, 7(2):168-172.
12.	Li Z, Tian M, Zhang CY, et al. A Randomised Controlled Trial to Evaluate the Effectiveness of Intrathecal Bupivacaine Combined with Different Adjuvants (Fentanyl, Clonidine and Dexmedetomidine) in Caesarean Section. Drug Res (Stuttg), 2014, DOI:10.1055/s-0034-1395614.
13.	Higgins JP, Green S. Conchrane Handbook for Systematic Reviews of Interventions 5.1.0[updated March 2011]. The Cochrane Collaboration 2011.
14.	宋娟, 葛亚丽, 龙丰云. 右美托咪定对老年腹腔镜手术患者术后认知功能的影响. 吉林医学, 2015, 36(2):212-214.
15.	关应军, 陈勇, 苏圣贤, 等. 亚麻醉剂量氯胺酮与负荷剂量右美托咪定对老年人腹腔镜术后认知功能障碍的影响. 中国医药导报, 2015, 3:61-63.
16.	张奕文. 盐酸右美托咪啶联合乌司他丁对腹腔镜下结直肠癌手术老年患者术后早期认知功能障碍的影响. 南方医科大学, 2014.
17.	宋晓阳, 周翔, 甘国胜, 等. 右美托咪定对老年直肠癌患者术后认知功能的影响. 华南国防医学杂志, 2014, 28(11):1073-1075.
18.	柏平, 闫东, 税春玲. 术中使用右美托咪啶对老年患者术后认知功能的影响. 重庆医学, 2013, 42(18):2107-2109.
19.	杨秀娟, 张强, 关维. 右美托咪定对老年患者全麻术后认知功能的影响. 黑龙江医药科学, 2013, 36(5):103-105.
20.	Chen J, Yan J, Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp Ther Med, 2013, 5(2):489-494.
21.	莫坚, 莫桂熙, 刘亦君, 等. 盐酸右美托咪定对老年腹部手术患者术后认知功能障碍的影响. 实用医学杂志, 2012(24):4150-4152.
22.	Hovens IB, Schoemaker RG, van der Zee EA, et al. Postoperative cognitive dysfunction:Involvement of neuroinflammation and neuronal functioning. Brain Behav Immun, 2014(38):202-210.
23.	Abildstrom H, Rasmussen LS, Rentowl P, et al. Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction. Acta Anaesthesiol Scand, 2000, 44(10):1246-1251.
24.	Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand, 2010, 54(8):951-956.
25.	Qian XL, Zhang W, Liu MZ, et al. Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice. Eur J Pharmacol, 2015, 746:206-212.
26.	Cibelli M, Fidalgo AR, Terrando N, et al. Role of interleukin-1beta in postoperative cognitive dysfunction. Ann Neurol, 2010, 68(3):360-368.
27.	陈伟强, 郑春勤, 黄声鑫, 等. 右美托咪定对老年患者术后认知功能的影响的系统评价. 岭南现代临床外科, 2014, 14(5):543-548.
28.	Neerland BE, Hov KR, Bruun Wyller V, et al. The protocol of the Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID:a randomised placebo-controlled trial. BMC Geriatr, 2015, 15:7.
29.	方梅, 努尔波拉提·加列力汗, 禚海成, 等. 右美托咪定对老年患者全髋关节置换术后早期认知功能的影响. 临床麻醉学杂志, 2012, 28(12):1175-1177.
30.	Rasmussen LS, O'Brien JT, Silverstein JH, et al. Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? Acta Anaesthesiol Scand, 2005, 49(9):1225-1231.
31.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand, 2005, 49(8):1088-1091.
32.	Khan ZP, Munday IT, Jones RM, et al. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1:Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth, 1999, 83(3):372-380.
33.	杨百武, 张庆, 杜京承, 等. 右美托咪定对全麻子宫切除术中血流动力学及应激反应的影响. 临床麻醉学杂志, 2015, 31(1):26-28.

1. Steinmetz J, Christensen KB, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 2009, 110(3):548-555.
2. Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res, 2011, 5(2):128-133.
3. Nishizawa T, Suzuki H, Sagara S, et al. Dexmedetomidine versus midazolam for gastrointestinal endoscopy:a meta-analysis. Dig Endosc, 2015, 27(1):8-15.
4. Lin YY, He B, Chen J, et al. Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis. Crit Care, 2012, 16(5):R169.
5. Turunen H, Jakob SM, Ruokonen E, et al. Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care:an economic evaluation. Crit Care, 2015, 19(1):67.
6. Chen K, Lu Z, Xin YC, et al. Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. Cochrane Database Syst Rev, 2015, 1:CD010269.
7. Bong CL, Lim E, Allen JC, et al. A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging. Anaesthesia, 2015, 70(4):393-399.
8. Ayeko M, Mohamed AA. Prevention and treatment of sevoflurane emergence agitation and delirium in children with dexmedetomidine. Saudi J Anaesth, 2015, 9(1):103.
9. Patel A, Davidson M, Tran MC, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Anal, 2010, 111(4):1004-1010.
10. Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12):1098-1104.
11. Hanoura SE, Hassanin R, Singh R. Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia. Anesth Essays Res, 2013, 7(2):168-172.
12. Li Z, Tian M, Zhang CY, et al. A Randomised Controlled Trial to Evaluate the Effectiveness of Intrathecal Bupivacaine Combined with Different Adjuvants (Fentanyl, Clonidine and Dexmedetomidine) in Caesarean Section. Drug Res (Stuttg), 2014, DOI:10.1055/s-0034-1395614.
13. Higgins JP, Green S. Conchrane Handbook for Systematic Reviews of Interventions 5.1.0[updated March 2011]. The Cochrane Collaboration 2011.
14. 宋娟, 葛亚丽, 龙丰云. 右美托咪定对老年腹腔镜手术患者术后认知功能的影响. 吉林医学, 2015, 36(2):212-214.
15. 关应军, 陈勇, 苏圣贤, 等. 亚麻醉剂量氯胺酮与负荷剂量右美托咪定对老年人腹腔镜术后认知功能障碍的影响. 中国医药导报, 2015, 3:61-63.
16. 张奕文. 盐酸右美托咪啶联合乌司他丁对腹腔镜下结直肠癌手术老年患者术后早期认知功能障碍的影响. 南方医科大学, 2014.
17. 宋晓阳, 周翔, 甘国胜, 等. 右美托咪定对老年直肠癌患者术后认知功能的影响. 华南国防医学杂志, 2014, 28(11):1073-1075.
18. 柏平, 闫东, 税春玲. 术中使用右美托咪啶对老年患者术后认知功能的影响. 重庆医学, 2013, 42(18):2107-2109.
19. 杨秀娟, 张强, 关维. 右美托咪定对老年患者全麻术后认知功能的影响. 黑龙江医药科学, 2013, 36(5):103-105.
20. Chen J, Yan J, Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp Ther Med, 2013, 5(2):489-494.
21. 莫坚, 莫桂熙, 刘亦君, 等. 盐酸右美托咪定对老年腹部手术患者术后认知功能障碍的影响. 实用医学杂志, 2012(24):4150-4152.
22. Hovens IB, Schoemaker RG, van der Zee EA, et al. Postoperative cognitive dysfunction:Involvement of neuroinflammation and neuronal functioning. Brain Behav Immun, 2014(38):202-210.
23. Abildstrom H, Rasmussen LS, Rentowl P, et al. Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction. Acta Anaesthesiol Scand, 2000, 44(10):1246-1251.
24. Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand, 2010, 54(8):951-956.
25. Qian XL, Zhang W, Liu MZ, et al. Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice. Eur J Pharmacol, 2015, 746:206-212.
26. Cibelli M, Fidalgo AR, Terrando N, et al. Role of interleukin-1beta in postoperative cognitive dysfunction. Ann Neurol, 2010, 68(3):360-368.
27. 陈伟强, 郑春勤, 黄声鑫, 等. 右美托咪定对老年患者术后认知功能的影响的系统评价. 岭南现代临床外科, 2014, 14(5):543-548.
28. Neerland BE, Hov KR, Bruun Wyller V, et al. The protocol of the Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID:a randomised placebo-controlled trial. BMC Geriatr, 2015, 15:7.
29. 方梅, 努尔波拉提·加列力汗, 禚海成, 等. 右美托咪定对老年患者全髋关节置换术后早期认知功能的影响. 临床麻醉学杂志, 2012, 28(12):1175-1177.
30. Rasmussen LS, O'Brien JT, Silverstein JH, et al. Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? Acta Anaesthesiol Scand, 2005, 49(9):1225-1231.
31. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand, 2005, 49(8):1088-1091.
32. Khan ZP, Munday IT, Jones RM, et al. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1:Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth, 1999, 83(3):372-380.
33. 杨百武, 张庆, 杜京承, 等. 右美托咪定对全麻子宫切除术中血流动力学及应激反应的影响. 临床麻醉学杂志, 2015, 31(1):26-28.

Chinese Journal of Evidence-Based Medicine

Effect of Dexmedetomidine on Postoperative Cognitive Dysfunction of Chinese Patients undergoing Abdominal Surgeries: A Meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content