The Effects Of Lidocaine And Dexmedetomidine On Short-term Postoperative Cognitive Function In Elderly Patients Undergoing Spinal Surgery

Objective:Elderly patients are prone to cognitive impairment after surgery,which will affect their quality of life.And there is currently no precise treatment.In this study,we mainly observed the effects of intravenous infusion lidocaine and dexmedetomidine on short-term postoperative cognitive function in elderly patients undergoing spinal surgery and want to provide more clinical practice for preventing and treating postoperative cognitive dysfunction（POCD）.Methods:There were 90 elderly patients who were over 65 years old and planned to undergo spinal surgery under general anesthesia.They were enrolled and randomly divided into control group（C group）,dexmedetomidine group（D group）,and lidocaine group（L group）,with 30 cases in each group.Patients in L group were pumped lidocaine（1 mg/kg）10 min before the induction of anesthesia,and then lidocaine was intravenously pumped at a rate of 1mg·kg^-1·h^-1 until 30 min before the end of operation.Patients in D group were pumped dexmedetomidine（0.5μg/kg）10 min before the induction of anesthesia,and then dexmedetomidine was intravenously pumped at a rate of0.5μg·kg^-1·h^-1 until 30 min before the end of surgery.Patients in C group were given the same volume of normal saline.The cognitive function of the three groups of patients was measured by the Mini-mental state examination（MMSE）at 1 d before surgery,1 d after surgery and 3 d after surgery,and the incidence of POCD was recorded.The serum levels of interleukin（IL）-6 and neuron specific enolase（NSE）were detected at 1 d before surgery（T1）,end of surgery（T2）and 1 d after surgery（T3）.The time of operation,extubation and stay in the resuscitation room was recorded,and the occurrence of adverse reactions such as nausea and vomiting,bradycardia and hypotension was recorded.Results:1.There were no significant differences in baseline data of patients in each group including gender,age,body mass index,ASA classification,years of education,MMSE score,and operation time（P>0.05）.2.The time of extubation and stay in the resuscitation room in D group was longer than that in L group and C group,and the difference was statistically significant（P<0.05）.There was no significant difference between the C group and L group（P>0.05）.3.There was no significant difference in the serum levels of IL-6 and NSE in the three groups of patients at 1 d before surgery（T1）（P>0.05）.Compared to the time point of T1,the serum levels of IL-6 and NSE in the three groups of patients were higher at the end of surgery（T2）and 1 d after surgery（T3）,and the difference was statistically significant（P<0.05）.Compared to the C group,the serum levels of IL-6 and NSE in the D group and L group were lower at the time points of T2 and T3,and the difference was statistically significant（P<0.05）.But there was no significant difference between the D group and L group（P>0.05）.4.There was no significant difference in the MMSE scores of the three groups of patients at 1 d before surgery（P>0.05）.Compared to the same group at 1 d before surgery,the MMSE scores of the C group and L group were lower at 1 d after surgery and 3 d after surgery,and the difference was statistically significant（P<0.05）.The MMSE score of D group at 1 d after surgery was lower than that at 1 d before surgery,and the difference was statistically significant（P<0.05）.Compared to the C group,the MMSE scores of D group and L group were higher at 1 d after surgery and 3 d after surgery,and the difference was statistically significant（P<0.05）,while the difference between D group and L group was not statistically significant（P>0.05）.5.The incidence of adverse reactions such as nausea and vomiting,bradycardia and hypotension in the three groups was not statistically significant（P>0.05）.Compared to the C group,the incidence of POCD was lower in D group and L group after surgery,and the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of POCD between D group and L group（P>0.05）.Conclusion:Intravenous infusion lidocaine and dexmedetomidine have beneficial effects on short-term cognitive function in elderly patients after spinal surgery,which may be related to their anti-inflammation and neuroprotection.