Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: A randomized double blinded controlled trial

STUDY OBJECTIVE: To evaluate effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy. DESIGN: Randomized, double-blind study. SETTING: University-affiliated teaching hospital. PATIENTS: One hundred and fifty-two elderly patients scheduled for shoulder arthroscopy. INTERVENTIONS: At 15 min before the induction of anesthesia, 152 patients received intravenously parecoxib sodium 40 mg and dexmedetomidine at a dose of 0.5 μg/kg over 15 min, followed by a continuous infusion at a rate of 0.5 μg/kg/h until the end of surgery. Then all patients who received postoperative patient-controlled intravenous analgesia were divided 2 groups: sufentanil(0.04μg/kg/h, S group), sufentanil (0.04μg/kg/h) plus dexmedetomidine(0.06μg/kg/h) (SD group). MEASUREMENTS: The mini–mental status examination score in SD group was significantly higher than S group at 1, 2 and 7 days after surgery. The incidence of postoperative cognitive dysfunction during 7 days after surgery in S and SD groups was respectively 17.1% and 6.7%. Compared with the S group, the visual analogue scale scores at rest and upon movement were significantly lower at 6, 14, 24, 36 and 48 h after surgery in SD group; analgesia pump liquid amount during 24 h after surgery and number of rescue analgesia during 48 h after surgery were significantly lower in SD group. Jugular venous oxygen partial pressure and jugular venous oxygen saturation values in SD group were significantly higher than S group at postoperative 24 h. The occurrence of nausea and vomiting within 48 h after surgery in SD group were significantly lower than S group. We found no complications including respiratory depression and sinus bradycardia within 48 h after surgery in all patients. CONCLUSIONS: Parecoxib sodium pretreatment combined with dexmedetomidine could reduce the incidence of early postoperative cognitive dysfunction in elderly patients. This might be related to the improvement of postoperative analgesia effect and cerebral oxygen metabolism in patients.