Key result
Intraoperative dexmedetomidine significantly reduced the incidence of postoperative delirium to 9.9% compared to 25.3% with standard care in elderly patients undergoing total laryngectomy.
Why the study?
Postoperative cognitive dysfunction is commonly encountered after major surgical operations, prompting evaluation of the effect of dexmedetomidine on neurocognitive dysfunction and recovery after total laryngectomy in elderly patients.
Does intraoperative dexmedetomidine improve postoperative cognitive functions and reduce delirium in elderly patients undergoing total laryngectomy?
RCT (n=182)
Closed envelope method
No
Does intraoperative dexmedetomidine improve postoperative cognitive functions and reduce delirium in elderly patients undergoing total laryngectomy?
Absolute Event Rate: 9.9% vs 25.3%
p-value: p=0.006
Intraoperative dexmedetomidine significantly improves postoperative cognitive function and reduces delirium in elderly patients undergoing total laryngectomy, though it increases the risk of bradycardia and hypotension.
Hypothesis-generating for dexmedetomidine in laryngectomy; larger randomized trials needed before clinical adoption.
Background Postoperative cognitive dysfunction is commonly encountered after major surgical operations. This study was conducted to evaluate the effect of dexmedetomidine on neurocognitive dysfunction and postoperative recovery after total laryngectomy in the elderly population. Results Preoperative characteristics were comparable between the two groups. However, both sevoflurane consumption and recovery time were significantly decreased in the Dex group. Also, the time to first analgesic request and sedation level showed a significant improvement in the same group. The Dex group showed its superiority regarding most of the used cognitive tests. Although there was no significant difference between the two study groups regarding basal S100B, postoperative levels significantly decreased in the Dex group. Conclusions Dexmedetomidine administration is associated with a significant improvement of cognitive function after surgery in the elderly population. It is associated with a better analgesic and sedative profile along with decreased neurological inflammatory markers. However, the patient must be closely monitored for side effects like bradycardia and hypotension.
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El-Shamy et al. (2022) conducted an RCT in Postoperative cognitive dysfunction and delirium after total laryngectomy (n=182). Dexmedetomidine vs. Standard anesthetic protocol was evaluated on Incidence of postoperative delirium within 5 days (p=0.006). Intraoperative dexmedetomidine significantly reduced the incidence of postoperative delirium to 9.9% compared to 25.3% with standard care in elderly patients undergoing total laryngectomy.
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