Effects of dexamethasone on early cognitive decline after cardiac surgery

医学 地塞米松 入射(几何) 安慰剂 麻醉 置信区间 术后认知功能障碍 心脏外科 随机对照试验 内科学 外科 认知 精神科 光学 物理 病理 替代医学
作者
Sandro Glumac,Goran Kardum,Lidija Šodić,Daniela Šupe‐Domić,Nenad Karanović
出处
期刊:European Journal of Anaesthesiology [Lippincott Williams & Wilkins]
卷期号:34 (11): 776-784 被引量:74
标识
DOI:10.1097/eja.0000000000000647
摘要

BACKGROUND Postoperative cognitive decline (POCD), a very common complication after cardiac surgery, is characterised by impairment of both memory function and intellectual ability as well as being associated with increased use of healthcare resources. The investigators focused on the role of the inflammatory response to a surgical procedure as a potential factor involved in the pathogenesis of POCD. OBJECTIVE The use of prophylactic dexamethasone to attenuate the inflammatory response was hypothesised to reduce the risk of POCD. DESIGN Randomised controlled study. SETTING Single university teaching hospital, from March 2015 to January 2016. PATIENTS A total of 169 patients scheduled for elective cardiac surgery were enrolled, and 161 patients were included in the analyses. INTERVENTION Patients were randomised to receive a single intravenous bolus of 0.1 mg kg−1 dexamethasone (n = 85) or placebo (n = 84) 10 h before the surgery. MAIN OUTCOME MEASURES The primary outcome measure in both groups was the incidence of POCD on the 6th day after surgery. The investigators also evaluated the effect of dexamethasone on the incidence of systemic inflammatory response syndrome, postoperative C-reactive protein levels and postoperative serum S100β protein levels. RESULTS Compared to the placebo group, the dexamethasone group showed statistically significant reductions in the incidence of POCD (relative risk, 0.43; 95% confidence interval, 0.21 to 0.89; P = 0.02), the incidence of systemic inflammatory response syndrome (30.0 versus 58.0%, P < 0.001) and postoperative C-reactive protein levels (P < 0.001). Postoperative S100β levels were insignificantly lower (P = 0.56) in the dexamethasone group. CONCLUSION Preoperative administration of dexamethasone reduced the inflammatory response and thereby decreased the risk of early POCD after cardiac surgery. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02767713.
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