Effect of sedation with regional anesthesia with dexmedetomidine on postoperative cognitive function in elderly patients with diabetes mellitus
10.3760∕cma.j.issn.0254-1416.2017.11.004
- VernacularTitle:右美托咪定区域麻醉镇静对糖尿病老年患者术后认知功能的影响
- Author:
Xiaoyun HU
1
;
Binjiang ZHAO
;
Yue SU
;
Xiuyun WANG
;
Pengfei LIU
;
Lihong SHEN
Author Information
1. 100038,首都医科大学附属北京世纪坛医院麻醉科
- Keywords:
Dexmedetomidine;
Aged;
Diabetes mellitus;
Cognition;
Postoperative com-plications
- From:
Chinese Journal of Anesthesiology
2017;37(11):1296-1299
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effect of sedation with regional anesthesia with dexmedeto-midine on postoperative cognitive function in elderly patients with diabetes mellitus. Methods A total of 180 elderly patients of either sex with diabetes foot, aged 65-80 yr, weighing 45-90 kg, of American So-ciety of Anesthesiologists physical status ⅡorⅢ, with preoperative Mini-Mental State Examination score>24, undergoing elective débridement, were divided into 2 groups(n=90 each)using a random number table: sedation with dexmedetomidine group(group D)and routine sedation control group(group C). Lumbar plexus block and sciatic nerve block were performed, after the reliable efficacy was achieved, dexmedetomidine was intravenously infused in a dose of 0.5 μg∕kg for 10 min followed by an infusion of 0.5 μg·kg-1·h-1until the end of surgery. Midazolam 0.02-0.04 mg∕kg was intravenously injected and mid-azolam 1 mg was injected intermittently during operation in group C. Ramsay sedation scores were main-tained between 2 and 4. At 30 min before surgery(T1), 1 h after the beginning of surgery(T2), at the end of surgery(T3), 6 h after the end of surgery(T4), and 24 h after the end of surgery(T5), venous blood samples were collected for determination of the level of blood glucose and plasma cortisol(Cor)con-centrations. Mini-Mental State Examination scores were assessed at 1 day before surgery and 1 and 3 days after surgery, and the occurrence of postoperative cognitive dysfunction was recorded in a short time period after operation. Results Compared with the baseline at T1, the level of blood glucose at T2-5and plasma Cor concentrations at T3,4were significantly increased in group C, and plasma Cor concentrations were sig-nificantly increased at T3,4(P<0.05), and no significant change was found in the level of blood glucose at T2-5in group D(P>0.05). Compared with group C, the level of blood glucose at T3-5and plasma Cor con-centrations at T3,4were significantly decreased, Mini-Mental State Examination scores were increased at 1 and 3 days after operation, and the incidence of postoperative cognitive dysfunction in a short time period after operation was decreased in group D(P<0.05). Conclusion Sedation with regional anesthesia with dexmedetomidine can improve postoperative cognitive function in elderly patients with diabetes mellitus.
