Background: Elderly patients are more vulnerable to anesthesia-related cognitive dysfunction. Spinal
surgery consumes long theater time that may affect patients' outcome especially the elderly ones.
Anesthetic manipulations were supposed to modulate cognitive outcomes of patients.
Objectives: Evaluation of the effect of intraoperative (IO) dexmedetomidine (DEX) infusion during
spinal surgery on the incidence and severity of postoperative cognitive disorders (POCD).
Patients & Methods: 152 patients were divided into Group P received placebo infusion and Group D
DEX infusion (0.5 µg/kg/h) with induction of anesthesia until wound closure. Cognitive function (CF)
was assessed using Mini-Mental State Examination (MMSE) pre- and postoperatively. The median
value of CF deficit in 4-wk PO was calculated and its correlation to type of IO infusions and patients'
data was evaluated. The effect of DEX infusion on the incidence and severity of POCD is the study
outcome.
Results: DEX infusion significantly decreased the incidence and severity of POCD with significantly
lower deficit in MMSE score of patients of group D. The MMES deficit was positively correlated to
age, body mass index (BMI), presence of systemic diseases and infusion type. The use of DEX, young
age, and low BMI are significant predictors for normal CF.
Conclusion: DEX infusion for elderly patients undergoing major surgeries of long operative time and
predicted blood loss significantly reduced the incidence and severity of POCD. The used dose of DEX
was appropriate for preserving CF without hemodynamic effects. |
