Why the study?
Postoperative cognitive dysfunction is a common neurological disorder in surgical patients, and the comparative efficacy of different anesthetic drugs in reducing its incidence among elderly patients undergoing noncardiac surgery was unclear.
Do specific anesthetic drugs reduce the incidence of postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery?
Do specific anesthetic drugs reduce the incidence of postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery?
Sufentanil and dexmedetomidine appear to be the most effective anesthetic drugs for reducing the incidence of postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery.
POCD incidence reaches 27.7% under placebo; extends RCT evidence on anesthetic selection to reduce cognitive risk.
Postoperative cognitive dysfunction (POCD) is a common neurological system disorder in surgical patients. The choice of anesthetic can potentially reduce POCD. The authors performed this network meta-analysis to compare different anesthetic drugs in reducing the incidence of POCD for elderly people undergoing noncardiac surgery. We searched MEDLINE, EMBASE, the Cochrane Library, and the Web of Science for randomized controlled trials comparing the different anesthetic drugs for noncardiac surgery in elderly from inception until July, 2022. The protocol was registered on the PROSPERO database (CRD#42020183014). A total of 34 trials involving 4314 patients undergoing noncardiac surgery in elderly were included. The incidence of POCD for each anesthetic drug was placebo (27.7%), dexmedetomidine (12.9%), ketamine (15.2%), propofol (16.8%), fentanyl (23.9%), midazolam (11.3%), sufentanil (6.3%), sevoflurane (24.0%), and desflurane (28.3%). Pairwise and network meta-analysis showed dexmedetomidine was significantly reducing the incidence of POCD when compared with placebo. Network meta-analysis also suggested dexmedetomidine was significantly reducing the incidence of POCD when compared with sevoflurane. Sufentanil and dexmedetomidine ranked the first and second in reducing the incidence of POCD with the surface under the cumulative ranking curve value of 87.4 and 81.5%. Sufentanil and dexmedetomidine had the greatest possibility to reduce the incidence of POCD for elderly people undergoing noncardiac surgery.
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Zeng et al. (2023) studied this question.
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