Effects of Anesthetic Adjunctive Agents on Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Noncardiac Surgery: A Bayesian Network Meta-analysis

Overview

Journal Brain Behav

Specialty Psychology

Date 2023 Jul 11

PMID 37431799

Authors

Lichi Xu

Shuxiang Xu

Yuelun Zhang

Yuguang Huang

Affiliations

Soon will be listed here.

Abstract

Background: Elderly patients are prone to postoperative cognitive dysfunction (POCD). The comparison of the effects of anesthetic adjuvant drugs on POCD in elderly patients undergoing noncardiac surgery remains controversial.

Methods: The final search took place on June 10, 2023. Randomized controlled trials including ketamine, ulinastatin, dexmedetomidine, parecoxib, and midazolam on the prevention and treatment of POCD in elderly undergoing noncardiac surgery were collected. A Bayesian network meta-analysis was performed to quantitatively combine the evidence.

Results: A total of 35 randomized trials were finally included in this systematic review, and the overall risk of bias is Allocation concealment. These anesthetic adjuvant drugs did not show significant differences in preventing POCD on postoperative days 1 and 7 compared with each other, but ulinastatin may be more effective in preventing POCD than dexmedetomidine [odds ratio (OR) = 0.28, 95% confidence interval (CI) = (0.10, 0.71)] and parecoxib [OR = 0.3, 95% CI = (0.10, 0.82 on postoperative day 3. The efficiency ranking results also find that ulinastatin and ketamine might provide better effects regarding POCD prevention.

Conclusions: Ketamine and ulinastatin might have better effects in preventing POCD in elderly patients undergoing noncardiac surgery. Our meta-analysis provided evidence for the use of ulinastatin and ketamine in the prevention of POCD in elderly patients undergoing noncardiac surgery.

Citing Articles

The effect of anesthesia on postoperative cognitive dysfunction in adults undergoing cataract surgery: a systematic review.

Foroughi E, Brogi E, Forfori F, Hashemi S BMC Anesthesiol. 2025; 25(1):35.

PMID: 39849420 PMC: 11755816. DOI: 10.1186/s12871-025-02897-3.

The influence of low-dose s-ketamine on postoperative delirium and cognitive function in older adults undergoing thoracic surgery.

Wang Y, Ma B, Wang C, Wang Y, Liu A, Hang L J Cardiothorac Surg. 2024; 19(1):324.

PMID: 38849859 PMC: 11157807. DOI: 10.1186/s13019-024-02811-x.

Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta-analysis.

Xu L, Xu S, Zhang Y, Huang Y Brain Behav. 2023; 13(8):e3149.

PMID: 37431799 PMC: 10454282. DOI: 10.1002/brb3.3149.

References

Li M, Yang Y, Ma Y, Wang Q . Pharmacological Agents That Prevent Postoperative Cognitive Dysfunction in Patients With General Anesthesia: A Network Meta-analysis. Am J Ther. 2021; 28(4):e420-e433. DOI: 10.1097/MJT.0000000000001271. View

Hovaguimian F, Tschopp C, Beck-Schimmer B, Puhan M . Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta-analysis. Acta Anaesthesiol Scand. 2018; 62(9):1182-1193. DOI: 10.1111/aas.13168. View

Mansouri N, Nasrollahi K, Shetabi H . Prevention of Cognitive Dysfunction after Cataract Surgery with Intravenous Administration of Midazolam and Dexmedetomidine in Elderly Patients Undergoing Cataract Surgery. Adv Biomed Res. 2019; 8:6. PMC: 6385669. DOI: 10.4103/abr.abr_190_18. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Rasmussen L . Postoperative cognitive dysfunction: incidence and prevention. Best Pract Res Clin Anaesthesiol. 2006; 20(2):315-30. DOI: 10.1016/j.bpa.2005.10.011. View

Zeiler F, Teitelbaum J, Gillman L, West M . NMDA antagonists for refractory seizures. Neurocrit Care. 2014; 20(3):502-13. DOI: 10.1007/s12028-013-9939-6. View

Duan M, Liu F, Fu H, Feng S, Wang X, Wang T . Effect of Ulinastatin on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Surgery: A Systemic Review and Meta-Analysis. Front Neurosci. 2021; 15:618589. PMC: 8265373. DOI: 10.3389/fnins.2021.618589. View

Glumac S, Kardum G, Sodic L, Supe-Domic D, Karanovic N . Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial. Eur J Anaesthesiol. 2017; 34(11):776-784. DOI: 10.1097/EJA.0000000000000647. View

Evered L, Silbert B, Knopman D, Scott D, DeKosky S, Rasmussen L . Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-2018. Anesthesiology. 2018; 129(5):872-879. DOI: 10.1097/ALN.0000000000002334. View

10.

Huang J, Lv Z, Zhang B, Jiang W, Nie M . Intravenous parecoxib for early postoperative cognitive dysfunction in elderly patients: evidence from a meta-analysis. Expert Rev Clin Pharmacol. 2020; 13(4):451-460. DOI: 10.1080/17512433.2020.1732815. View

11.

Krenk L, Rasmussen L, Kehlet H . New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand. 2010; 54(8):951-6. DOI: 10.1111/j.1399-6576.2010.02268.x. View

12.

Brodier E, Cibelli M . Postoperative cognitive dysfunction in clinical practice. BJA Educ. 2021; 21(2):75-82. PMC: 7810820. DOI: 10.1016/j.bjae.2020.10.004. View

13.

Li J, Yin Q, Xun X, He J, Yu D, Wang Z . The effect of intraoperative dexmedetomidine on cognitive dysfunction after surgery: a updated meta-analysis. J Cardiothorac Surg. 2021; 16(1):351. PMC: 8670116. DOI: 10.1186/s13019-021-01736-z. View

14.

Mu D, Zhang D, Wang D, Wang G, Li C, Meng Z . Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial. Anesth Analg. 2017; 124(6):1992-2000. DOI: 10.1213/ANE.0000000000002095. View

15.

Lu J, Chen G, Zhou H, Zhou Q, Zhu Z, Wu C . 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. J Clin Anesth. 2017; 41:30-34. PMC: 5558812. DOI: 10.1016/j.jclinane.2017.06.004. View

16.

Chen J, Jia J, Liu T, Qin M, Li W . Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children. Can J Anaesth. 2013; 60(4):385-92. DOI: 10.1007/s12630-013-9886-x. View

17.

Zhu Y, Yao R, Zhang Z, Xu H, Wang L . Parecoxib prevents early postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty: A double-blind, randomized clinical consort study. Medicine (Baltimore). 2016; 95(28):e4082. PMC: 4956786. DOI: 10.1097/MD.0000000000004082. View

18.

Huang X, Sun Y, Lin D, Wei C, Wu A . Effect of perioperative intravenous lidocaine on the incidence of short-term cognitive function after noncardiac surgery: A meta-analysis based on randomized controlled trials. Brain Behav. 2020; 10(12):e01875. PMC: 7749605. DOI: 10.1002/brb3.1875. View

19.

Belrose J, Noppens R . Anesthesiology and cognitive impairment: a narrative review of current clinical literature. BMC Anesthesiol. 2019; 19(1):241. PMC: 6933922. DOI: 10.1186/s12871-019-0903-7. View

20.

Lili X, Zhiyong H, Jianjun S . A preliminary study of the effects of ulinastatin on early postoperative cognition function in patients undergoing abdominal surgery. Neurosci Lett. 2013; 541:15-9. DOI: 10.1016/j.neulet.2013.02.008. View