Effect of sedation with regional anesthesia with dexmedetomidine on postoperative cognitive function in elderly patients with diabetes mellitus / 中华麻醉学杂志

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.