Effects Of Different Depth Of Anesthesia Combined With Dexmedetomidine On Postoperative Delirium After Unilateral Hip Or Knee Replacement

Objective:To explore the effect of different depth of anesthesia combined with dexmedetomidine on postoperative delirium in elderly patients undergoing unilateral hip or knee replacement.Methods:A total of 60 elderly patients over 60 years old who underwent unilateral hip or knee arthroplasty in our hospital were randomly divided into the light anesthesia group(group D1,n=30)and the deep anesthesia group(group D2,n=30).According to Narcotrend index,their depth of anesthsia control in D1 level(NI:47-56)and combined injection of dexmedetomidine in D1 group.The Narcotrend index was maintained at37-46 in D2 group(the rest being the same as D1 group).The MMSE scores and hemoglobin&albumin levels were recorded on the day before operation.Record intraoperative anesthetic dosage,blood loss,urine output,anesthesia duration,fluid volume and intraoperative blood pressure fluctuations.The CAM score,hemoglobin and albumin examination results of the patients were recorded on 1,3,and 5 days after the operation.Results:There was no significant difference in age,BMI,gender,preoperative MMSE score,history of hypertension,history of diabetes and other general conditions between the two groups(P>0.05).The dosage of propofol in the D2 group increased(314.66±76.066mg vs 289.67 mg±51.292mg)compared with the D1 group,and the difference was statistically significant(P<0.05),and there was no statistical difference in other anesthetic drugs.The incidence of POD in D1 group and D2 group was 16.67%VS 23.33%within 5 days after surgery(X~2=0.417,P=0.519).The level of hemoglobin and albumin in the two groups decreased after operation compared with that before operation(P<0.05).However,there was no significant difference between two groups in hemoglobin and albumin levels.Conclusion:Intraoperative monitoring of anesthesia depth at stage D1and D2 through Narcotrend and the combined infusion of dexmedetomidine showed no significant difference in the incidence of POD in the short-term postoperation.However,monitoring the anesthsia depth can guide accurate anesthetic drug use and reduce their dosage.The correlation analysis suggested that preoperative diabetes mellitus,postoperative anemia and advanced age were correlated with the occurrence of POD.