Effects Of Dexamethasone On Postoperative Cognitive Dysfunction And Delirium In Adults Following General Anesthesia:A Meta Analysis

Objective:We conducted a meta-analysis to determine the effects of dexamethasone on postoperative cognitive dysfunction(POCD)and postoperative delirium(POD)in adults following general anesthesia.Methods:Cochrane、MEDLINE OvidSP、Embase OvidSP、Wan Fang and China National Knowledge Infrastructure were searched for randomized controlled trials that evaluated the incidence of POCD/POD following dexamethasone administration.Two researchers independently performed literature screening,data extraction and quality evaluation according to inclusion and exclusion criteria.Meta-analysis was performed using Revman 5.0 software.Result:Ultimately,eight randomized controlled studies were included,four studies on postoperative cognitive dysfunction,three studies on postoperative delirium,and one study on both postoperative cognitive dysfunction and postoperative delirium.The results of meta-analysis showed that there was no significant difference in the incidence of postoperative cognitive dysfunction between the dexamethasone group and the control group(1738 patients,RR=0.73,95%CI[0.41,1.30],P=0.28,I~2=82%).There was no significant difference in the incidence of postoperative delirium between the dexamethasone group and the control group(1267 patients,RR=0.83,95%CI[0.68,1.02],P=0.08,I~2=0%),nor on first postoperativeday(RR=0.69,95%CI[0.32,1.47],P=0.33,I~2=74%),or on third postoperative day(RR=0.66,95%cCI[0.33,1.30],P=0.23,I~2=66%).The length of hospital stay in the dexamethasone group was slightly shorter than that in the control group(WMD-0.57d;95%CI[-1.08,-0.07],P=0.03,I~2=0%),but the difference was so small that there was no clinical significance;The ICU time of dexamethasone group was shorter than that of the control group(WMD-13.37 h,95%CI[-21.41,-5.32],P=0.001.I~2=34%).Conclusion:Dexamethasone did not reduce the incidence of POCD/POD,nor the POD of the first and third postoperative day;Although the hospitalization time in the dexamethasone group was slightly shorter than that in the control group,the difference was so small that there was no clinical significance;Dexamethasone can effectively reduces the long of ICU stay.