The Effect of Intravenous Midazolam and Dexmedetomidine on Prevention of Cognitive Dysfunction after Cataract Surgery in the Elderly Patients under General Anesthesia Compared with the Control Group

Document Type : Original Article (s)

Authors

1 Professor, Department of Anesthesiology, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

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

3 Associate Professor, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

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

Abstract

Background: This study aimed to evaluate the effect of intravenous midazolam and dexmedetomidine on prevention of cognitive dysfunction after cataract surgery in the elderly patients under general anesthesia compared with the control group.Methods: In this clinical trial study, 150 patients underwent phacoemulsification surgery were selected and randomly divided into three equal groups. The three groups received 0.1 mg/kg midazolam, 1 mg/kg dexmedetomidine, and similar volume of normal saline, respectively before the surgery. The cognitive dysfunction scores were measured and compared using Mini-Mental Status Examination (MMSE) criteria before and after the surgery.Findings: The preoperative frequency of cognitive dysfunction was 6, 10, and 4 percent in midazolam, dexmedetomidine, and control groups, respectively (P = 0.47). 24 hours after the surgery, 14, 12, and 10 percent of the patients had cognitive dysfunction (P = 0.83); while one week after surgery, 8, 12, and 6 percent of patients had cognitive dysfunction in the three groups of midazolam, dexmedetomidine and control, respectively with no statistical difference between the three groups (P = 0.56).Conclusion: The effect of midazolam and dexmedetomidine was similar on prevention of the incidence of cognitive dysfunction, and it is possible to use the both drugs, if there is no contraception to use them.

Keywords

References

  1. 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].
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth 2009; 103 Suppl 1: i41-i46.
  8. Rohan D, Buggy DJ, Crowley S, Ling FK, Gallagher H, Regan C, et al. Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly. Can J Anaesth 2005; 52(2): 137-42.
  9. Newman S, Stygall J, Hirani S, Shaefi S, Maze M. Postoperative cognitive dysfunction after noncardiac surgery: A systematic review. Anesthesiology 2007; 106(3): 572-90.
  10. Bekker A, Haile M, Kline R, Didehvar S, Babu R, Martiniuk F, et al. The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery. J Neurosurg Anesthesiol 2013; 25(1): 16-24.
  11. Ke JJ, Zhang ZZ, Feng XB, Chen K, Yao, Wang YL. Efficacy of different doses of dexmedetomidine for prevention of postoperative cognitive dysfunction in elderly patients undergoing hyperthermic intraperitoneal chemotherapy. Chinese Journal of Anesthesiology 2013; (10): 1192-4.
  12. Trivedi D. Cochrane Review Summary: Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Prim Health Care Res Dev 2017; 18(6): 527-8.
  13. Naghibi K, Nazemroaya B, Sargaran A. A comparison of the effect of intravenous dexamethasone and lidocaine on prevention of postoperative cognitive disorders in cataract surgery in elderly patients. J Isfahan Med Sch 2018; 36(484): 666-72. [In Persian].
  14. Naghibi K, Kashefi P, Abtahi AM. The comparison of preemptive effects of propofol, remifentanil and ketamine on post-operative pain scores and analgesic requirements in elective lower abdominal surgery under general anesthesia: A randomized, double-blinded study. J Res Med Sci 2013; 18(7): 567-72.
  15. Naghibi K, Moradi-Farsani D, Hirmandpour A, Forutan A. Comparison of the effect of dexamethasone, acetaminophen, and normal saline on the prevention of headache in patients under elective cesarean section. J Isfahan Med Sch 2017; 35(424): 345-50. [In Persian].
  16. Rahimi M, Montazeri K, Kamali L, Moradi M, Naghibi Kh. comparing the effects of magnesium sulfate and nitroglycerin on the control of hypertension during and after cataract surgery under local anesthesia and intravenous sedation. J Isfahan Med Sch 2016; 33(361): 2076-83. [In Persian].
Journal of Isfahan Medical School
Volume 36, Issue 504 - Serial Number 504
September and October 2019
Pages 1395-1400

Files

History

  • Receive Date: 09 August 2018
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics