Effect Of Dexmedetomidine On Postoperative Delirium In Elderly Patients Undergoing Electroprostatectomy

Objective:To investigate the effect of dexmedetomidine on postoperative delirium in elderly patients undergoing electroprostatectomy.Methods:Atotalof100elderlypatientswhounderwent electroprostatectomy under tracheal intubation under general anesthesia were randomly divided into dexmedetomidine group（group D）and control group（group C）,with 50 patients in each group.ASA is level I^III,aged from 65 to80 years old.The mini-mental state examination MMSE was conducted the day before the surgery,and the score was over 17.Patients in the two groups were given targeted infusion of propofol at 2-5 ug/ml,1-3 ng/ml of remifentanil and0.2 mg/kg of cis-atracurium for anesthesia induction and mechanical assisted ventilation after tracheal intubation.Patients in the dexmedetomidine group（group D）received intravenous infusion of 0.3 ug/kg/h dexmedetomidine during anesthesia induction until 20 min before the end of surgery.Patients in the control group（group C）were injected with normal saline by the same method.The central venous pressure（CVP）of the two groups was controlled at 5-12cmH₂O after the surgery.When the CVP was increased by 5 cmH₂O or more than 12 cmH₂O before the surgery,furosemide was injected.When the CVP was lower than 5 cmH₂O,an appropriate amount of fluid could be replenishment.Intraoperative based on eeg double-frequency index（Bispectral index,BIS）adjustment of propofol and fentanyl dosage.Records of patients after entering the operating room（T0）,pump injection right beautiful mi or saline after 30 min（T1）,electricity cut after 30 min（T2）,when the tracheal catheter removal（T3）,15 min after the tracheal catheter removal（T4）,heart rate（HR）and mean arterial pressure（MAP）.After the operation,the time of operation,anesthesia,extubation time and waking time,blood loss,ephedrine,atropine,nitroglycerin,esmolol,furosemide,propofol and remifentanil were counted.The delirium rating scale（cam-cr）was used to evaluate the delirium rate on the first day after surgery,the first day after surgery,the second day after surgery and the third day after surgery.Results:Comparison of general preoperative data:there were no statistically significant differences in age,ASA classification,BMI,education level,MMSE score at visit,and preoperative disease status（P>0.05）.Comparison of intraoperative medication between the two groups:the dosage of propofol,remifentanil and furosemide in group D was significantly lower than that in group C（P<0.05）.Vital signs of patients at each time point:Compared with T0,HR and MAP at T1 points in group D were significantly reduced,with statistically significant differences（P<0.05）,while HR and MAP at T1 points in group C were not significantly changed,with no statistically significant differences（P>0.05）.Compared with group C,HR and MAP at T1,T2,T3 and T4 points in group D all decreased significantly,and the difference was statistically significant（P<0.05）.Postoperative delirium of patients in the two groups:postoperative delirium occurred in both groups,but group D was significantly lower than group C,and the difference was statistically significant（P<0.05）.Comparison of postoperative adverse reactions between the two groups:tachycardia,bradycardia,hypoxemia,hypertension,hypotension,vomiting,chills,etc,the differences were not statistically significant（P>0.05）.Conclusion:Dexmedetomidine can reduce or prevent postoperative delirium in elderly patients undergoing electroprostatectomy,and can also effectively reduce the use of intraoperative remifentanil and propofol,stabilize hemodynamics during anesthesia and convalescence.