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：

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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

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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, 葛亞麗, 龍豐云. 右美托咪定對老年腹腔鏡手術患者術后認知功能的影響. 吉林醫學, 2015, 36(2):212-214.
15.	關應軍, 陳勇, 蘇圣賢, 等. 亞麻醉劑量氯胺酮與負荷劑量右美托咪定對老年人腹腔鏡術后認知功能障礙的影響. 中國醫藥導報, 2015, 3:61-63.
16.	張奕文. 鹽酸右美托咪啶聯合烏司他丁對腹腔鏡下結直腸癌手術老年患者術后早期認知功能障礙的影響. 南方醫科大學, 2014.
17.	宋曉陽, 周翔, 甘國勝, 等. 右美托咪定對老年直腸癌患者術后認知功能的影響. 華南國防醫學雜志, 2014, 28(11):1073-1075.
18.	柏平, 閆東, 稅春玲. 術中使用右美托咪啶對老年患者術后認知功能的影響. 重慶醫學, 2013, 42(18):2107-2109.
19.	楊秀娟, 張強, 關維. 右美托咪定對老年患者全麻術后認知功能的影響. 黑龍江醫藥科學, 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.	莫堅, 莫桂熙, 劉亦君, 等. 鹽酸右美托咪定對老年腹部手術患者術后認知功能障礙的影響. 實用醫學雜志, 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.	陳偉強, 鄭春勤, 黃聲鑫, 等. 右美托咪定對老年患者術后認知功能的影響的系統評價. 嶺南現代臨床外科, 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, 努爾波拉提·加列力汗, 禚海成, 等. 右美托咪定對老年患者全髖關節置換術后早期認知功能的影響. 臨床麻醉學雜志, 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.	楊百武, 張慶, 杜京承, 等. 右美托咪定對全麻子宮切除術中血流動力學及應激反應的影響. 臨床麻醉學雜志, 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, 葛亞麗, 龍豐云. 右美托咪定對老年腹腔鏡手術患者術后認知功能的影響. 吉林醫學, 2015, 36(2):212-214.
15. 關應軍, 陳勇, 蘇圣賢, 等. 亞麻醉劑量氯胺酮與負荷劑量右美托咪定對老年人腹腔鏡術后認知功能障礙的影響. 中國醫藥導報, 2015, 3:61-63.
16. 張奕文. 鹽酸右美托咪啶聯合烏司他丁對腹腔鏡下結直腸癌手術老年患者術后早期認知功能障礙的影響. 南方醫科大學, 2014.
17. 宋曉陽, 周翔, 甘國勝, 等. 右美托咪定對老年直腸癌患者術后認知功能的影響. 華南國防醫學雜志, 2014, 28(11):1073-1075.
18. 柏平, 閆東, 稅春玲. 術中使用右美托咪啶對老年患者術后認知功能的影響. 重慶醫學, 2013, 42(18):2107-2109.
19. 楊秀娟, 張強, 關維. 右美托咪定對老年患者全麻術后認知功能的影響. 黑龍江醫藥科學, 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. 莫堅, 莫桂熙, 劉亦君, 等. 鹽酸右美托咪定對老年腹部手術患者術后認知功能障礙的影響. 實用醫學雜志, 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. 陳偉強, 鄭春勤, 黃聲鑫, 等. 右美托咪定對老年患者術后認知功能的影響的系統評價. 嶺南現代臨床外科, 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, 努爾波拉提·加列力汗, 禚海成, 等. 右美托咪定對老年患者全髖關節置換術后早期認知功能的影響. 臨床麻醉學雜志, 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. 楊百武, 張慶, 杜京承, 等. 右美托咪定對全麻子宮切除術中血流動力學及應激反應的影響. 臨床麻醉學雜志, 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

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