RESUMO
OBJECTIVE: To compare the analgesic and sleep quality effects of dexmedetomidine infusion versus placebo in patients undergoing cardiac surgery with ultra-fast track extubation. DESIGN: The randomized, double-blind clinical trial study. SETTING: At a single academic center hospital. PARTICIPANTS: We included patients aged 25 to 65 scheduled for elective cardiac surgery under general anesthesia with cardiopulmonary bypass from October 2021 to December 2022. INTERVENTION: After immediate extubation in the operating room, the patients who were allocated at first after providing their consent to either the dexmedetomidine group (Dex) or the placebo group (Placebo) received continuous infusion of dexmedetomidine (0.2 µg/kg/h) or saline for 12 hours postoperatively. MEASUREMENTS AND MAIN RESULTS: The groups' demographic and perioperative variables were not statistically significant. Total morphine consumption in milligrams at 12 and 24 hours after administered study drug, total sleep time in hours by BIS value ≤85, and sleep quality with the Richard-Campbell Sleep Questionnaire were compared. The analysis included 22 Dex and 23 Placebo patients. The consumption of morphine was not statistically different between the Dex and Placebo groups at 12 and 24 hours (p = 0.707 and p = 0.502, respectively). The Dex group had significantly longer sleep time (8.7 h [7.8, 9.5]) than the Placebo group (5.8 h [2.9, 8.5]; p = 0.007). The Dex group also exhibited better sleep quality (7.9 [6.7, 8.7] vs 6.6 [5.2, 8.0]; p = 0.038). CONCLUSIONS: Sedation with low-dose dexmedetomidine infusion for ultra-fast track extubation following cardiac surgery enhances sleep duration and quality.
RESUMO
BACKGROUND: Perioperative neurocognitive disorder includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). Concerning inconclusive consequences of POCD compared with POD, we explored the association between either POCD or POD and functional decline as well as healthcare utilization. METHODS: Patients aged at least 60 years who underwent a major operation were enrolled. POCD was defined as a decrease in the Montreal Cognitive Assessment (MoCA) score (≥ 2) 1 week after surgery. Postoperative delirium (POD) was defined according to the criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The primary outcome was instrumental activities of daily living (IADLs) 3 months after discharge. Secondary outcomes were the length of stay (LOS), hospital cost, and factors that affected functional decline 3 months after surgery. The multivariate model, including potential confounding factors, namely age, gender, surgery type, and postoperative complications, was used to analyze possible factors that influenced a reduction in function, and the results were expressed by using adjusted relative risk (RR) and 95%CI. RESULTS: Two hundred eighty-nine patients with a mean age of 72 years were enrolled. The incidence of POCD at 1 week was 28.5%. At their 3-month follow-ups, the patients with POCD were not associated with IADL decline. Nevertheless, patients with POCD were more likely to need a prolonged LOS (11 days [1, 46] vs. 8 days [2, 42]; P = 0.01), and incur higher hospital costs (8973.43 USD [3481.69, 11 763.74] vs. 5913.62 USD [332.43, 19 567.33]; P < 0.001). Additionally, the patients experiencing POD demonstrated increased risks of reducing their IADLs (adjusted RR 2.33; 95% CI, 1.15-4.71; P = 0.02). CONCLUSIONS: POCD at 1 week leaded to increase healthcare utilization in a middle-income country. POD during hospitalization was associated with a decline in function after surgery and increased health care utilization. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20190115001 .
