Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia A double-blind, randomised clinical trial
Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia A double-blind, randomised clinical trial
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DOI：
10.1097/eja.0000000000001382
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发表时间：
2021-03-01
影响因子：
3.6
通讯作者：
Maze, Mervyn
中科院分区：
文献类型：
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作者：
Hu, Jun;Zhu, Mudan;Maze, Mervyn
已知右美托咪定是镇静剂。最近的研究表明，右美托咪定给药可以预防术后谵妄（POD），这已被证实是大手术后的常见并发症。然而，它对接受食管切除术的患者的影响却很少。目的探讨右美托咪定减少老年患者全凭静脉麻醉（TIVA）经胸食管切除术后POD的有效性和安全性。设计：随机、双盲、安慰剂对照试验。设置单中心，三级护理医院，2016年11月至2018年9月。接受经胸食管切除术的合格患者（n = 177）被随机分配接受全静脉麻醉（TIVA，n = 87）或右美托咪定联合TIVA（DEX-TIVA，n = 90）。干预接受DEX-TIVA的患者接受负荷剂量的右美托咪定（0.4 μ g kg（-1）），持续15分钟，然后以0.1 μ g kg（-1）h（-1）的速率持续输注，直至手术结束前1小时。接受TIVA的患者接受生理盐水，输注速率方案相似。主要观察指标为POD的发生率。次要终点为出现激越的发生率、血清白细胞介素-6（IL-6）水平和血液动力学特征。结果：所有随机化患者均纳入计划的POD意向治疗分析。右美托咪定组90例中15例（16.7%）发生谵妄，生理盐水组87例中32例（36.8%）发生谵妄（P = 0.0036）。DEX-TIVA组的苏醒期激越频率低于TIVA组（22.1 vs. 48.0%，P = 0.0058）。TIVA组手术诱导的IL-6水平增量变化大于DEX-TIVA组（P < 0.0001）。结论：在全静脉麻醉中加入右美托咪定可安全减少老年患者行开放性经胸食管切除术后的POD和苏醒期躁动。这些益处与术后促炎细胞因子IL-6循环水平降低和血流动力学特征稳定相关。
BACKGROUND Dexmedetomidine is known to be a sedative. Recent studies suggest that administration of dexmedetomidine can prevent postoperative delirium (POD) which has been confirmed as a common complication after major surgery. However, its effects in patients undergoing oesophagectomy are scarce. OBJECTIVE To investigate the efficacy and safety of dexmedetomidine in reducing POD in elderly patients after transthoracic oesophagectomy with total intravenous anaesthesia (TIVA). DESIGN A randomised, double-blind, placebo-controlled trial. SETTING Single-centre, tertiary care hospital, November 2016 to September 2018. PATIENTS Eligible patients (n = 177) undergoing transthoracic oesophagectomy were randomly assigned to receive total intravenous anaesthesia (TIVA, n = 87) or dexmedetomidine with TIVA (DEX-TIVA, n = 90). INTERVENTIONS Patients receiving DEX-TIVA received a loading dose of dexmedetomidine (0.4 mu g kg(-1)), over 15 min, followed by a continuous infusion at a rate of 0.1 mu g kg(-1) h(-1) until 1 h before the end of surgery. Patients receiving TIVA received physiological saline with a similar infusion rate protocol. OUTCOME MEASURES The primary outcome was the incidence of POD. The secondary endpoints were the incidence of emergence agitation, serum interleukin-6 (IL-6) levels and haemodynamic profile. RESULTS All randomised patients were included with planned intention-to-treat analyses for POD. Delirium occurred in 15 (16.7%) of 90 cases given dexmedetomidine, and in 32 (36.8%) of 87 cases given saline (P = 0.0036). The DEX-TIVA group showed less frequent emergence agitation than the TIVA group (22.1 vs. 48.0%, P = 0.0058). The incremental change in surgery-induced IL-6 levels was greater in the TIVA group than DEX-TIVA group (P < 0.0001). CONCLUSION Adding peri-operative dexmedetomidine to a total intravenous anaesthetic safely reduces POD and emergence agitation in elderly patients undergoing open transthoracic oesophagectomy. These benefits were associated with a postoperative reduction in circulating levels of the pro-inflammatory cytokine IL-6 and stabilisation of the haemodynamic profile.