The Combinational Effects Of Dexmedetomidine And Creatine Phosphate Sodium On Postoperative Delirium In Elderly Patients With Radical Resection Of Esophageal Carcinoma

Objective： To observe the effects of dexmedetomidine, CreatinePhosphate Sodium and the combination of both on Postoperative delirium inelderly patients with radical resection of esophageal carcinoma so as to findmore effective methods in reducing the prevalence of postoperative cognitivedysfunction (POCD) in elderly patients with radical resection of esophagealcarcinoma.Methods:80elderly patients, with ages≥65and defined as AmericanSociety of Anesthesiologist gradeⅠ-Ⅱ(ASA),underwent selective esophagealcarcinoma resection surgery. All recruits gave their written consent exceptthose with nervous system and mental diseases, long period exposure tosedatives and antidepressants, history of alcoholism or drug dependence,apparent cardiovascular, liver and renal dysfunctions, incompliance duringpre-operation test, difficulty in communication and incapability to completefollow-up visits.80patients were divided into four groups (20for each group):group I (control), group II (dexmedetomidine), group III (Creatine PhosphateSodium) and group IV (dexmedetomidine and Creatine Phosphate Sodium).All patients received general anesthesia with endotracheal intubation methodwithout giving any medication before operation. Name, sex, age andadmittance No. were checked for each patient before surgery. Riger’s solutionwas infused through vein access. Vital signs such as Heart rate (HR), pulseoxygen saturation (Spo2, electrocardiogram (ECG), non-invasive bloodpressure (NIBP) were monitored. Radial artery and right internal jugularcentral vein were punctured to monitor invasive blood pressure (ART) andcentral venous pressure (CVP), respectively. Infusion velocity was adjustedfollowing CVP changes.4ml central venous blood was withdrawn before induction of anesthesia and let stand for30min before it was centrifuged atRT.2ml serum was separated by centrifugation at4000r/min under coolcondition and stored at-80℃. S-100β level in serum was determined byELISA kit. Group I patients were given20ml NS10min before induction ofanesthesia; group II patients were given20ml NS containing certain amountof dexmedetomidine(0.4μg per kg body weight)10min before induction ofanesthesia; group III patients were given20ml NS containing4.0g CreatinePhosphate Sodium10min before induction of anesthesia; group IV patientswere given10ml NS containing certain amount of dexmedetomidine(0.4μg perkg body weight) plus10ml NS containing4.0g Creatine Phosphate Sodium10min before induction of anesthesia. For induction of anesthesia, Patients infour groups were infused slowly with fentanyl citrate at2-4μg/kg andintravenous injection of etomidate at0.1-0.3mg/kg, and then injection ofcisatracurium at0.15mg/kg when patients lost consciousness. Oxygen wasgiven with pressurized mask and once intubation conditions were met, doublelumen endotracheal tube was inserted through mouth under photopic vision.Patients were given2-3%sevoflurane inhalant and infused with fentanyl at0.1-0.2μg/(kg min) and intermittent injection of cisatrucurium during surgeryto maintain anesthetic status. BIS value was maintained in the range of40-60during the surgery. Esmolol or atropine should be used to decrease or increasethe HR once the fluctuation of HR exceeded±20%of base value; urapidil orephedrine should be used to decrease or increase the blood pressure,respectively, once it exceeded±20%of base value. For postoperativeanesthesia, four group patients received an infusion (2ml/h)(100ml) with thesame formula: fentanyl (4μg/kg)+dezocine (0.4mg/kg)+NS. Mini-mentalstate examination (MMSE) scores of the four group patients were determinedthe day before surgery (T0) and the first day after surgery (T1)(an MMSEscore difference larger than2before surgery and after surgery was consideredPostoperative delirium) as well as sleep quality score.4ml venous blood waswithdrawn and visual analogue scale was determined on the first day aftersurgery (T1). VAS scores were recorded during resting and activities and the results were defined as: excellent when VAS<3, good when VAS was in therange of3-4and poor when VAS≥5.Results: parameters such as sex, age, height, body weight, years ofeducation, duration of surgery, intraoperative blood pressure, oxygensaturation, heart rate and S100β concentration, MMSE score and sleep qualityscore before surgery and visual analogue score after surgery all showed nosignificant differences(p>0.05).MMSE score comparison results among four groups were as following:Infour groups, MMSE scores on T1were lower than T0and the difference wasstatistically significant (p<0.05).Between the four groups:For group II, III andgroup IV, MMSE score on T1was lower than group I and the difference wasstatistically significant (p<0.05).For group IV, MMSE score on T1was lowerthan group II, III and the difference was statistically significant (p<0.05).Sleep quality score comparison results among four groups were asfollowing:Sleep quality score comparisons on the first day after surgery, T1was lower than T0in group II and the difference was statistically significant(p<0.05); T1was lower than T0in group IV and the difference wasstatistically significant (p<0.05); T1was higher than T0in group I and thedifference was statistically significant (p<0.05); T1and T0in group III was nosignificant differences(p>0.05).Comparison of S100β in four groups after surgery：Comparison of S100βconcentration among four groups: group II was lower than group I and thedifference was statistically significant(p<0.05); group III was lower thangroup I and the difference was statistically significant(p<0.05); group IV waslower than group I and the difference was statistically significant(p<0.05);group II was lower than group III and the difference was statisticallysignificant(p<0.05); group IV was lower than group II and the difference wasstatistically significant(p<0.05); group IV was lower than group III and thedifference was statistically significant(p<0.05).Conclusions: single use of dexmedetomidine or Creatine PhosphateSodium all could reduce the prevalence of Postoperative delirium in elderly patients with radial resection of esophageal carcinoma, but with combinationof both drugs, better results were observed which might be due to mechanismof brain and nerve protection. Variations in S-100β level might be an indicatorreflecting the prevalence of Postoperative delirium in elderly patientsundergoing general anesthesia.