Published online Jan 19, 2024. doi: 10.5498/wjp.v14.i1.26
Peer-review started: August 30, 2023
First decision: September 13, 2023
Revised: October 11, 2023
Accepted: December 5, 2023
Article in press: December 5, 2023
Published online: January 19, 2024
Most elderly patients are prone to various complications in the perioperative period, such as postoperative delirium and cognitive dysfunction. Cognitive dysfunction seriously affects the postoperative rehabilitation of patients, prolongs hospital stay, increases the incidence of postoperative complications and mortality, in addition to a serious decline in personal quality of life, but also increases the burden of the family and society. Many researchers believe that advanced age and “major surgery” are important risk factors for cognitive dysfunction in patients undergoing non-cardiac surgery. Therefore, cognitive dysfunction is an important issue in the medical field at present, and the study of the occurrence factors, pathogenesis, effective prevention, and treatment of cognitive dysfunction is an important topic in the field of anesthesiology.
It is unclear whether the combination of ulinastatin and dexmedetomidine (Dex) can further reduce the incidence of postoperative cognitive dysfunction (POCD) in elderly patients undergoing total hip arthroplasty (THA). Therefore, the current study aims to evaluate the effect of ulinastatin combined with Dex on POCD and emergence agitation. Therefore, solving these problems could effectively improve the postoperative stress response and improve the sedation effect for elderly patients undergoing THA. This is the first study to explore the effect of ulinastatin combined with Dex on POCD and emergence agitation in elderly patients undergoing THA.
In view of the high incidence of POCD in elderly orthopedic patients, this study will compare the effects of different anesthetic methods on the early cognitive function of elderly patients after THA, and explore the related factors, to provide some guidance for the anesthetic mode and anesthetic management of clinical orthopedic surgery in the future. The purpose of this study is to provide clinical basis for the selection of anesthesia in elderly patients undergoing hip arthroplasty.
In this study, we collected the postoperative data, including visual analogue scale (VAS) scores at 24 h after operation, postoperative stress response indicators [Mini-Mental State Examination (MMSE) scores, hemodynamic indexes, observer’s assessment of alertness/sedation (OAA/S) scale and Ramsay score], inflammatory cytokines [C-reactive protein (CRP) and interleukin (IL)-6]. A total of 129 patients administrated with Dex 0.3 μg/kg/h during the operation were included in the Dex group. One hundred fifty patients who were intravenously injected 5000 U/kg of ulinastatin 15 min before anesthesia were included in the ulinastatin group. One hundred eighteen patients who were administrated with 5000 U/kg of ulinastatin (15 min before anesthesia) combined with Dex 0.3 μg/kg/h during the operation were included in the Dex + ulinastatin group.
The findings of this study demonstrated that ulinastatin combined with Dex could reduce the incidence of POCD in elderly patients undergoing THA, and the mechanism might be associated with the lessening of plasma levels of CRP and IL-6. Moreover, the combination of ulinastatin and Dex can reduce postoperative pain and postoperative stress response in elderly patients undergoing THA. Our results validated that the combination therapy can effectively improve the cognitive function of nervous system after operation and improved the quality of life for patients.
This is the first study explored the efficacy of ulinastatin combined with Dex on POCD and emergence agitation in elderly patients undergoing THA. We collected the postoperative data, including VAS scores at 24 h after operation, postoperative stress response indicators (MMSE scores, hemodynamic indexes, OAA/S scale, CRP, and IL-6). The results of this study not only demonstrate that combination therapy can reduce postoperative cognitive impairment, but also find that the mechanism may be related to the reduction of plasma levels of CRP and IL-6.
In future research, we will focus on the specific mechanisms related to the combined therapy through in vitro and in vivo experiments.