Intraoperative dexmedetomidine infusion might help to preserve the cognitive function of geriatric patients undergoing arthroscopic shoulder surgery

Figures & data

Figure 1. Study flow chart.

Table 1. Baseline data of patients from both groups.

		Group S (n = 70)	Group D (n = 70)	P value
Age (years)		65.5 ± 3.5	65 ± 4	0.431
Gender	Males	27 (38.6%)	20 (28.6%)	0.210
	Females	43 (61.4%)	50 (71.4%)
BMI (kg/m^2)	Overweight	34 (48.6%)	27 (38.6%)	0.232
	Obese	36 (51.4%)	43 (61.4%)
	Mean (± SD)	30 ± 1.6	29.9 ± 1.8	0.650
ASA	Grade I	21 (30%)	16 (22.8%)	0.581
	Grade II	38 (54.3%)	40 (57.1%)
	Grade III	11 (15.7%)	14 (20%)
Co-morbidities	Yes	5 (7.1%)	8 (11.4%)	0.382
	No	65 (92.9%)	62 (88.6%)

Table 2. The finding detected during surgery for patients from both groups.

Parameters		Group S (n=70)	Group D (n=70)	P value
Duration of surgery (minutes)		64 ± 10.7	66.5 ± 8	0.118
HR (beats/min)	Preoperative	79.4 ± 4.4	79 ± 6.5	0.673
	After intubation	87.2 ± 3.9	84.8 ± 4.7	0.0012
	30-min IO	73.7 ± 6.2	71 ± 6.4	0.012
	60-min IO	74.7 ± 5.1	72.5 ± 5	0.010
	After extubation	81.6 ± 6	79.3 ± 5	0.015
MAP (mmHg)	Preoperative	83.7 ± 3.9	83.1 ± 4.1	0.377
	After intubation	89.5 ± 4.2	87.7 ± 4.5	0.017
	30-min IO	78.6 ± 3.1	76.5 ± 5.2	0.0045
	60-min IO	76.1 ± 6	73.3 ± 5.8	0.006
	After extubation	81.2 ± 5.7	79.3 ± 4.7	0.034

Table 3. Hemodynamic and pain data reported during postoperative course for patients from both groups.

Parameters	Time		Group S (n = 70)	Group D (n = 70)	P value
HR (beats/min)	At PACU		83.8 ± 4.5	82 ± 5.6	0.037
	1-h PO		84.9 ± 4	82.7 ± 5.7	0.009
	2-h PO		85.5 ± 5.3	83.4 ± 4.9	0.015
	4-h PO		86.5 ± 4.9	84.3 ± 6.2	0.022
	8-h PO		86.2 ± 5.5	84.4 ± 4.4	0.034
	12-h PO		87.4 ± 5.3	86.9 ± 5	0.109
MAP (mmHg)	At PACU		85.1 ± 4.6	82.9 ± 5.5	0.011
	1-h PO		84.1 ± 5.7	81.3 ± 6.8	0.009
	2-h PO		82.9 ± 5.3	81.1 ± 4.3	0.029
	4-h PO		83.5 ± 4.7	82 ± 4.2	0.048
	8-h PO		83.9 ± 4.2	82.6 ± 4.8	0.089
	12-h PO		86.1 ± 4.7	84.7 ± 5.2	0.095
NRS pain scores	At PACU		0.86 ± 0.73	0.67 ± 0.63	0.109
	1-h PO		1.29 ± 0.82	0.89 ± 0.6	0.0013
	2-h PO		1.81 ± 0.92	1.33 ± 0.74	0.0008
	3-h PO		2.46 ± 0.96	1.83 ± 0.8	<0.001
	4-h PO		2.59 ± 1.38	2.49 ± 0.9	0.612
	8-h PO		2.03 ± 1.56	2.56 ± 1.36	0.034
	12-h PO		1.64 ± 1.34	1.76 ± 1.61	0.719
	Average score		1.81 ± 0.37	1.63 ± 0.46	<0.001
PO analgesia	Times of requests	No	8 (11.4%)	22 (31.4%)	0.015
		One	57 (81.5%)	45 (64.3%)
		Two	5 (7.1%)	3 (4.3%)
	Duration till 1^st request (h)		6.4 ± 3.2	8.5 ± 3	0.0003
	Total dose of nalbufin (mg)		10.4 ± 1.4	9.7 ± 2.2	0.037

Table 4. The reported postoperative adverse events affected patients from both groups.

Parameters	Time		Group S (n = 70)	Group D (n = 70)	P value
Ramsey sedation score (after PACU transfer)	30-min	RSS = 2	29 (41.4%)	38 (54.3%)	0.128
		RSS = 3	41 (58.6%)	32 (45.7%)
	60-min	RSS = 2	37 (52.9%)	49 (70%)	0.037
		RSS = 3	33 (47.1%)	21 (30%)
	2-h	RSS = 2	42 (60%)	44 (62.9%)	0.728
		RSS = 3	28 (40%)	26 (37.1%)
PO hypotension			4 (5.7%)	7 (10%)	0.346
PO bradycardia			5 (7.1%)	9 (12.9%)	0.259
PO nausea	Score = 0		65 (92.9%)	67 (95.7%)	0.467
	Score = 1		5 (7.1%)	3 (4.3%)
Total incidence of adverse events			14 (20%)	19 (27.1%)	0.319

Figure 2. Mean value of MoCA score determined in the studied groups.

Table 5. Postoperative findings on Montreal Cognitive Assessment for patients from both groups.

Time				Group S (n = 70)	Group D (n=70)	P value
Preoperative	Normal CF			70 (100%)	70 (100%)	-
	Score (Mean ± SD)			27.3 ± 1.6	27.2 ± 1.5	0.707
48-PO	Quality of CF	Normal		45 (64.3%)	58 (82.9%)	0.034
		CD	Mild	13 (18.6%)	9 (12.9%)
			Moderate	8 (11.4%)	3 (4.2%)
			Severe	4 (5.7%)	0
	Significance vs. preoperative			<0.001	0.0014
	Score	Mean ± SD		22.5 ± 5.4	25.4 ± 2.7	0.0001
		Significance vs. preoperative		<0.001	<0.001
1-wk PO	Quality of CF	Normal		48 (68.6%)	60 (85.7%)	0.015
		CD	Mild	13 (18.5%)	9 (12.9%)
			Moderate	9 (12.9%)	1 (1.4%)
	Significance vs. preoperative			<0.001	0.0046
	Score	Mean ± SD		24.3 ± 4.9	25.8 ± 2.7	0.032
		Significance vs. preoperative		<0.001	0.0002
2-wk PO	Quality of CF	Normal		51 (72.9%)	64 (91.4%)	0.0066
		CD	Mild	13 (18.5%)	6 (8.6%)
			Moderate	6 (8.6%)	0
	Significance vs. preoperative			0.00002	0.012
	Score	Mean ± SD		25 ± 4.2	27 ± 1.9	.0004
		Significance vs. preoperative		0.0004	0.495

Figure 3. Mean value of MMSE score determined in the studied groups.

Table 6. Mini-mental state examination findings of patients from both groups.

Time				Group S (n = 70)	Group D (n = 70)	P value
Preoperative	Quality of CF	Normal		65 (92.9%)	64 (91.4%)	0.061
		Dysfunction	Mild	5 (7.1%)	6 (8.6%)
	Score (Mean ± SD)			25.9 ± 1.7	26.5 ± 2	0.707
48-PO	Quality of CF	Normal		23 (32.9%)	39 (55.7%)	0.022
		Dysfunction	Mild	28 (40%)	20 (28.6%)
			Moderate	19 (27.1%)	11 (15.7%)
		Significance vs. preoperative		<0.001	0.0005
	Score	Mean ± SD		21.4 ± 3.9	23.5 ± 3.5	0.0011
		Significance vs. preoperative		<0.001	<0.001
1-wk PO	Quality of CF	Normal		30 (42.9%)	47 (67.1%)	0.014
		Dysfunction	Mild	27 (38.5%)	17 (24.3%)
			Moderate	13 (18.6%)	6 (8.6%)
		Significance vs. preoperative		<0.001	0.001
	Score	Mean ± SD		23.2 ± 3.6	24.8 ± 2.7	0.0043
		Significance vs. preoperative		<0.001	0.00003
2-wk PO	Quality of CF	Normal		50 (71.4%)	61 (87.1%)	0.018
		Dysfunction	Mild	14 (20%)	8 (11.5%)
			Moderate	6 (8.6%)	1 (1.4%)
		Significance vs. preoperative		0.0022	0.507
	Score	Mean ± SD		25 ± 3	25.9 ± 2.1	.048
		Significance vs. preoperative		0.038	0.100

Table 7. Correlation analysis of the relation between cognitive function scorings and perioperative data.

	MoCA score		MMSE score
	“r”	P	“r”	P
Age	−0.338	<0.001	−0.304	<0.001
Female gender	−0.235	0.005	−0.057	0.504
BMI	−0.267	0.001	−0.179	0.034
ASA grade	0.002	0.985	−0.132	0.119
The use of DXM infusion	0.282	0.001	0.288	0.001
Operative time	−0.099	0.244	−0.164	0.052
PO pain score	−0.131	0.122	−0.151	0.075
The used dose of PO nalbuphine	−0.246	0.003	−0.257	0.002
The frequency of adverse events	−0.133	0.117	−0.195	0.021

Table 8. Regression analysis for the correlated perioperative data with CF scorings.

	Model-4		Model-3		Model-2		Model-1
Parameters	β	P	β	P	β	P	β	P
MoCA scoring
Age	−0.280	<0.001	−0.305	<0.001	−0.321	<0.001	−0.338	<0.001
Female gender	−0.228	0.003	0.249	0.001	excluded
BMI	−0.192	0.011	excluded
The use of DXM infusion	0.280	<0.001	0.288	<0.001	0.288	<0.001	0.276	0.001
Dose of PO nalbuphine	Excluded
Frequency of adverse events	Excluded
	Model-2				Model-1
Parameters	β		P		β		P
MMSE scoring
Age	−0.286		<0.001		−0.269		0.001
Female gender	Excluded				Excluded
BMI	Excluded				Excluded
The use of DXM infusion	0.296		<0.001		0.304		<0.001
Dose of PO nalbuphine	Excluded				Excluded
Frequency of adverse events	Excluded				Excluded

Figure 4. ROC curve analysis to define the predictive value of old age and the use of DXM infusion to predict the lowermost value of normal CF at 48-h PO (MMSE=25).

Figure 5. ROC curve analysis to define the predictive value of old age and the use of DXM infusion to predict the uppermost value for normal CF at 48-h PO (MMSE=25).