A Comparison of the Effect of Intravenous Dexamethasone and Lidocaine on Prevention of Postoperative Cognitive Disorders in Cataract Surgery in Elderly Patients

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Postoperative cognitive disorder is one of the most common complications after surgery especially in the elderly population, of which delirium is the most important. This complication may cause changes in personality and memory of patients, and increase postoperative complications. In this study, we decided to compare the preventative effects of intravenous administration of dexamethasone and lidocaine on postoperative cognitive disorder after cataract surgery in the elderly.Methods: In this double-blind clinical trial study with control group, 333 patients above 65 years of age were divided randomly into three groups receiving lidocaine, dexamethasone, and placebo. The cognitive scores before and after the surgery were compared between the groups.Findings: In the three groups receiving lidocaine, dexamethasone, and placebo, 6.4%, 3.6%, and 5.3% had cognitive disorder prior to surgery, respectively, which had no significant difference (P = 0.62). The prevalence of the postoperative cognitive disorders in the three groups of lidocaine, dexamethasone, and placebo was 12.0%, 9.9%, and 6.9%, respectively, which was not significantly different either (P = 0.98). The prevalence of cognitive disorders after one week in the three groups of lidocaine, dexamethasone, and placebo was 3.8%, 1.8%, and 8.8%, respectively, which was not significantly different (P = 0.98).Conclusion: The administration of lidocaine or dexamethasone had no significant effect in reducing postoperative cognitive disorder, but since the use of dexamethasone is limited in patients with cataract undergoing surgery due to various underlying medical conditions, using lidocaine is preferable in such patients.

Keywords

References

  1. Wacker P, Nunes PV, Cabrita H, Forlenza OV. Post-operative delirium is associated with poor cognitive outcome and dementia. Dement Geriatr Cogn Disord 2006; 21(4): 221-7.
  2. Agnoletti V, Ansaloni L, Catena F, Chattat R, De Cataldis A, Di Nino G, et al. Postoperative delirium after elective and emergency surgery: analysis and checking of risk factors. A study protocol. BMC Surg 2005; 5: 12.
  3. Oh YS, Kim DW, Chun HJ, Yi HJ. Incidence and risk factors of acute postoperative delirium in geriatric neurosurgical patients. J Korean Neurosurg Soc 2008; 43(3): 143-8.
  4. Morimoto Y, Yoshimura M, Utada K, Setoyama K, Matsumoto M, Sakabe T. Prediction of postoperative delirium after abdominal surgery in the elderly. J Anesth 2009; 23(1): 51-6.
  5. Juliebo V, Bjoro K, Krogseth M, Skovlund E, Ranhoff AH, Wyller TB. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc 2009; 57(8): 1354-61.
  6. Olin K, Eriksdotter-Jonhagen M, Jansson A, Herrington MK, Kristiansson M, Permert J. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg 2005; 92(12): 1559-64.
  7. Asaee R, Nasari H, Hoseini S. Prevalence of delirium in hospitalized internal medicine and surgical adult patients in Shohadaye ashayer hospital of Khoram abad. Yafte 2008; 10(3): 21-7. [In Persian].
  8. Pan LF, Wang DX, Li J. Effects of different methods of anesthesia and analgesia on early postoperative cognitive dysfunction after non-cardiac surgery in the elderly. Beijing Da Xue Xue Bao Yi Xue Ban 2006; 38(5): 510-4. [In Chinese].
  9. Anwer HM, Swelem SE, el-Sheshai A, Moustafa AA. Postoperative cognitive dysfunction in adult and elderly patients--general anesthesia vs subarachnoid or epidural analgesia. Middle East J Anaesthesiol 2006; 18(6): 1123-38.
  10. Echigoya Y, Kato H. Causes of postoperative delirium after abdominal surgery in elderly patients. Masui 2007; 56(8): 932-6. [In Japanese].
  11. Hall TA, McGwin G, Jr., Owsley C. Effect of cataract surgery on cognitive function in older adults. J Am Geriatr Soc 2005; 53(12): 2140-4.
  12. Ishii K, Kabata T, Oshika T. The impact of cataract surgery on cognitive impairment and depressive mental status in elderly patients. Am J Ophthalmol 2008; 146(3): 404-9.
  13. Tashakori A, Shanehsaz A, Khajeh Mougahi N. Comparison of incidence rate of post operative delirium between patients with open heart surgery and general surgery -Ahwaz Golestan Hospital 1999. Jundishapur Sci Med J 2004; 4(41): 37-43. [In Persian].
  14. Bryson GL, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth 2006; 53(7): 669-77.
  15. Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth 2009; 103(Suppl 1): i41-i46.
  16. Fang Q, Qian X, An J, Wen H, Cope DK, Williams JP. Higher dose dexamethasone increases early postoperative cognitive dysfunction. J Neurosurg Anesthesiol 2014; 26(3): 220-5.
  17. Ottens TH, Dieleman JM, Sauer AM, Peelen LM, Nierich AP, de Groot WJ, et al. Effects of dexamethasone on cognitive decline after cardiac surgery: A randomized clinical trial. Anesthesiology 2014; 121(3): 492-500.
  18. Sauer AM, Slooter AJ, Veldhuijzen DS, van Eijk MM, Devlin JW, van Dijk D. Intraoperative dexamethasone and delirium after cardiac surgery: A randomized clinical trial. Anesth Analg 2014; 119(5): 1046-52.
  19. Chen K, Wei P, Zheng Q, Zhou J, Li J. Neuroprotective effects of intravenous lidocaine on early postoperative cognitive dysfunction in elderly patients following spine surgery. Med Sci Monit 2015; 21: 1402-7.
  20. Mathew JP, Mackensen GB, Phillips-Bute B, Grocott HP, Glower DD, Laskowitz DT, et al. Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery. Stroke 2009; 40(3): 880-7.
Journal of Isfahan Medical School
Volume 36, Issue 484 - Serial Number 484
May and June 2018
Pages 666-672

Files

History

  • Receive Date: 20 April 2018
  • Revise Date: 02 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics