Top

Trials

Published in:

Open Access 01-12-2022 | Remifentanil | Research

The effects of remifentanil-propofol combined with dexmedetomidine on cognitive dysfunction in elderly patients after ureteroscopic holmium laser lithotripsy: a double-blind randomized controlled trial

Authors: Fangjun Wang, Dan Xie, Hongchun Xu, Qin Ye, Le Wu, Xiao Pei Gao

Published in: Trials | Issue 1/2022

Abstract

Background

A clinical study indicated that infusion of dexmedetomidine without a loading dose administered intraoperatively provided a smooth and hemodynamically stable emergence and improved the quality of recovery with fewer postoperative side effects and reduced analgesic requirements. The objective was to determine whether administering remifentanil-propofol combined with dexmedetomidine during general anesthesia would decrease the incidence and severity of postoperative emergence agitation, anxiety, and depression without affecting cognitive dysfunction in elderly patients.

Methods

A total of 120 elderly patients scheduled for ureteroscopic holmium laser lithotripsy were randomly allocated to the PR group and administered normal saline, and the PRD group was administered dexmedetomidine 0.4 μg kg⁻¹ h⁻¹ intravenously after the induction of anesthesia and stopped 30 min before the end of surgery. The primary outcome was the Mini-Mental State Examination score. The secondary outcomes were the Richmond Agitation Sedation, the State-Trait Anxiety Inventory, and the Zung Self-Rating Depression Scale scores; the memory span for Arabic numerals; the duration of surgery; and the time to spontaneous respiration, recovery, and extubation.

Results

The MMSE scores were lower at T_1–2 in the two groups (P < 0.001). The dosage of propofol and remifentanil decreased more significantly in the PRD group than in the PR group (P < 0.001). Both the RASS scores and the incidence of emergence agitation (EA) in the PRD group were significantly lower than those in the PR group at t_1–3 (P < 0.001). Compared to the PR group, the ZSDS scores and STAI scores at T_1–2 were lower in the PRD group (P < 0.005). The number of the Arabic numbers that were accurately recalled from memory was lower at T₂ in the PR group than in the PRD group (P < 0.001).

Conclusion

Dexmedetomidine administration has no influence on postoperative cognitive dysfunction but could reduce both the dosage of remifentanil and propofol needed during ureteroscopic holmium laser lithotripsy and the incidence and severity of postoperative emergence agitation, anxiety, and depression in elderly patients.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900021254. Registered on 3 February 2019

Lee JH, Kam EH, Kim SY, Cheon SY, Kim EJ, Chung S, et al. Erythropoietin attenuates postoperative cognitive dysfunction by shifting macrophage activation toward the M2 phenotype. Front Pharmacol. 2017;8:839. https://doi.org/10.3389/fphar.2017.00839 eCollection 2017.CrossRefPubMedPubMedCentral

Needham MJ, Webb CE, Bryden DC. Postoperative cognitive dysfunction and dementia: what we need to know and do. Br J Anaesth. 2017;119(suppl_1):i115–25. https://doi.org/10.1093/bja/aex354.CrossRefPubMed

Plas M, Rotteveel E, Izaks GJ, Spikman JM, van der Wal-Huisman H, van Etten B, et al. Cognitive decline after major oncological surgery in the elderly. Eur J Cancer. 2017;86:394–402. https://doi.org/10.1016/j.ejca.2017.09.024.CrossRefPubMed

Davis N, Lee M, Lin AY, Lynch L, Monteleone M, Falzon L, et al. Post-operative cognitive function following general versus regional anesthesia, a systematic review. J Neurosurg Anesthesiol. 2014;26(4):369–76. https://doi.org/10.1097/ANA.0000000000000120.CrossRefPubMedPubMedCentral

Geng YJ, Wu QH, Zhang RQ. Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunctionfollowing laparoscopic cholecystectomy in elderly patients: a randomized controlled trial. J Clin Anesth. 2017;38:165–71. https://doi.org/10.1016/j.jclinane.2017.02.007.CrossRefPubMed

Ekmekci P, Erkan G, Yilmaz H, Kazbek BK, Koksoy UC, Doganay G, et al. Effect of different sedation regimes on cognitive functions in colonoscopy. Euroasian J Hepato-Gastroenterol. 2017;7(2):158–62. https://doi.org/10.5005/jp-journals-10018-1239.CrossRef

Turgut N, Turkmen A, Ali A, Altan A. Remifentanil-propofol vs dexmedetomidine-propofol--anesthesia for supratentorial craniotomy. Middle East J Anaesthesiol. 2009;20(1):63–70.PubMed

Kim HC, Park HP, Lee J, Jeong MH, Lee KH. Sevoflurane vs. propofol in post-operative catheter-related bladder discomfort: a prospective randomized study. Acta Anaesthesiol Scand. 2017;61(7):773–80. https://doi.org/10.1111/aas.12922.CrossRefPubMed

Kim SY, Kim JM, Lee JH, Song BM, Koo BN. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth. 2013;111(2):222–8. https://doi.org/10.1093/bja/aet056.CrossRefPubMed

10.

Kerson AG, DeMaria R, Mauer E, Joyce C, Gerber LM, Greenwald BM, et al. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. J Intensive Care. 2016;4(1):65. eCollection 2016. https://doi.org/10.1186/s40560-016-0189-5.CrossRefPubMedPubMedCentral

11.

Heidari SM, Loghmani P. Assessment of the effects of ketamine-fentanyl combination versus propofol-remifentanil combination for sedation during endoscopic retrograde cholangiopancreatography. J Res Med Sci. 2014;19(9):860–6.PubMedPubMedCentral

12.

Li Y, He R, Chen S, Qu Y. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp Ther Med. 2015;10(5):1635–42. https://doi.org/10.3892/etm.2015.2726.CrossRefPubMedPubMedCentral

13.

Monk TG, Price CC. Postoperative cognitive disorders. Curr Opin Crit Care. 2011;17(4):376–81. https://doi.org/10.1097/MCC.0b013e328348bece.CrossRefPubMed

14.

Silbert BS, Evered LA, Scott DA. Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy. Br J Anaesth. 2014;113(5):784–91. https://doi.org/10.1093/bja/aeu163.CrossRefPubMed

15.

Ologunde R, Ma D. Do inhalational anesthetics cause cognitive dysfunction? Acta Anaesthesiol Taiwan. 2011;49(4):149–53. https://doi.org/10.1016/j.aat.2011.11.001.CrossRefPubMed

16.

Culley DJ, Flaherty D, Fahey MC, Rudolph JL, Javedan H, Huang CC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765–74. https://doi.org/10.1097/ALN.0000000000001859.CrossRefPubMed

17.

Wang FJ, Wang GF, Cai R, et al. Effects of remifentanil compound propofol and sevoflurane on cognitive and memory function in elderly patients. Chin J Gerontol. 2011;31(10):1894–6.

18.

Zywiel MG, Prabhu A, Perruccio AV, Gandhi R. The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clin Orthop Relat Res. 2014;472(5):1453–66. https://doi.org/10.1007/s11999-013-3363-2.CrossRefPubMed

19.

İlvan G, Özköse HZ. The effect of total intravenous anesthesia on the postoperative cognitive functions of young and elderly patients after lumbar disk surgery. Turk J Med Sci. 2015;45(1):191–6. https://doi.org/10.3906/sag-1311-29.CrossRefPubMed

20.

Wang Y, Sands LP, Vaurio L, Mullen EA, Leung JM. The effects of postoperative pain and its management on postoperative cognitive dysfunction. Am J Geriatr Psychiatry. 2007;15(1):50–9. https://doi.org/10.1097/01.jgp.0000229792.31009.CrossRefPubMed

21.

Kunimatsu T, Misaki T, Hirose N, Tsuboi E, Takahashi I, Ohki H, et al. Postoperative mental disorder following prolonged oral surgery. J Oral Sci. 2004;46(2):71–4. https://doi.org/10.2334/josnusd.46.71.CrossRefPubMed

22.

Magni G, Baisi F, La Rosa I, Imperiale C, Fabbrini V, Pennacchiotti ML, et al. No difference in emergence time and early cognitive function between sevoflurane–fentanyl and propofol–remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery. J Neurosurg Anesthesiol. 2005;17(3):134–8. https://doi.org/10.1097/01.ana.0000167447.33969.16.CrossRefPubMed

23.

Zhang D, Nie A. Assessment of different anesthesia depth under total intravenous anesthesia on postoperative cognitive function in laparoscopic patients. J Res Med Sci. 2016;21(1):73. eCollection 2016. https://doi.org/10.4103/1735-1995.189679.CrossRefPubMedPubMedCentral

24.

Poorzamany Nejat Kermany M, Dahi M, Yamini Sharif R, Radpay B. Comparison of the effects of dexmedetomidine and remifentanil on cognition state after cataract surgery. Anesth Pain Med. 2016;6(3):e33448. https://doi.org/10.5812/aapm.33448.CrossRefPubMedPubMedCentral

25.

Tan JA, Ho KM. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis. Intensive Care Med. 2010;36(6):926–39. https://doi.org/10.1007/s00134-010-1877-6.CrossRefPubMed

26.

Lu J, Chen G, Zhou H, Zhou Q, Zhu Z, Wu C. Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: a randomized double blinded controlled trial. J Clin Anesth. 2017;41:30–4. https://doi.org/10.1016/j.jclinane.2017.06.004.CrossRefPubMedPubMedCentral

27.

Kim HJ, Kim DK, Kim HY, Kim JK, Choi SW. Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Clin Exp Otorhinolaryngol. 2015;8(1):46–51. https://doi.org/10.3342/ceo.2015.8.1.46.CrossRefPubMedPubMedCentral

28.

Yu D, Chai W, Sun X, Yao L. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth. 2010;57(9):843–8. https://doi.org/10.1007/s12630-010-9338-9.CrossRefPubMed

29.

Munk L, Andersen G, Moller AM. Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences. Acta Anaesthesiol Scand. 2016;60(8):1059–66. https://doi.org/10.1111/aas.12717.CrossRefPubMed

30.

Kwon Y, Jang JS, Hwang SM, Lee JJ, Tark H. Intraoperative administration of dexmedetomidine reduced the postoperative catheter-relatedbladder discomfort and pain in patients undergoing lumbar microdiscectomy. J Anesth. 2018;32(1):41–7. https://doi.org/10.1007/s00540-017-2425-0.CrossRefPubMed

31.

Akça B, Aydoğan-Eren E, Canbay Ö, Karagöz AH, Üzümcügil F, Ankay-Yilbaş A, et al. Comparison of efficacy of prophylactic ketamine and dexmedetomidine on postoperative bladder catheter-related discomfort. Saudi Med J. 2016;37(1):55–9. https://doi.org/10.15537/smj.2016.1.14122.CrossRefPubMedPubMedCentral

32.

Kim HC, Lee YH, Jeon YT, Hwang JW, Lim YJ, Park JE, et al. The effect of intraoperative dexmedetomidine on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumour resection: a double-blind randomised study. Eur J Anaesthesiol. 2015;32(9):596–601. https://doi.org/10.1097/EJA.0000000000000196.CrossRefPubMed

33.

Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111(8):119–25. https://doi.org/10.3238/arztebl.2014.0119.CrossRefPubMedPubMedCentral

34.

Smith L, Jacob L, López-Sánchez GF, Butler L, Barnett Y, Veronese N, et al. Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries. J Affect Disord. 2021;291:57–64. https://doi.org/10.1016/j.jad.2021.04.076.CrossRefPubMed

35.

Williams OA, Demeyere N. Association of depression and anxiety with cognitive impairment 6 months after stroke. Neurology. 2021;96(15):e1966–74. https://doi.org/10.1212/WNL.0000000000011748.CrossRefPubMed

36.

Culpepper L, Lam RW, McIntyre RS. Cognitive impairment in patients with depression: awareness, assessment, and management. J Clin Psychiatry. 2017;78(9):1383–94. https://doi.org/10.4088/JCP.tk16043ah5c.CrossRefPubMed

Title: The effects of remifentanil-propofol combined with dexmedetomidine on cognitive dysfunction in elderly patients after ureteroscopic holmium laser lithotripsy: a double-blind randomized controlled trial
Authors: Fangjun Wang
Dan Xie
Hongchun Xu
Qin Ye
Le Wu
Xiao Pei Gao
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Remifentanil
Agitation
Anxiety
Propofol
Laser
Published in: Trials / Issue 1/2022
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/s13063-022-06121-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effects of remifentanil-propofol combined with dexmedetomidine on cognitive dysfunction in elderly patients after ureteroscopic holmium laser lithotripsy: a double-blind randomized controlled trial

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2022

Facilitating relaxation and stress reduction in healthy participants through a virtual reality intervention: study protocol for a non-inferiority randomized controlled trial

Comparison of different concentrations of a povidone iodine-diluted sitz bath in the prevention of perianal infection in patients undergoing chemotherapy for hematological malignancy: study protocol for a randomized controlled trial

Efficacy of the cognitive functional therapy (CFT) in patients with chronic nonspecific low back pain: a study protocol for a randomized sham-controlled trial

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: study protocol for the RETURN randomised controlled trial

Steroid treatment as anti-inflammatory and neuroprotective agent following out-of-hospital cardiac arrest: a randomized clinical trial

Intensified tuberculosis treatment to reduce the mortality of HIV-infected and uninfected patients with tuberculosis meningitis (INTENSE-TBM): study protocol for a phase III randomized controlled trial