Retracted Article: The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study

authors:

avatar Mahmoud Hussein Bahr ORCID 1 , avatar Doaa Abu Elkassim Rashwan ORCID 1 , avatar Samaa A Kasem ORCID 1 , *

Department of Anesthesia ,Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
Anesthesiology and Pain Medicine: Vol.11, issue 1; e107659
published online: December 2, 2020
article type: Research Article
received: July 22, 2020
revised: September 12, 2020
accepted: October 6, 2020
DOI: https://doi.org/10.5812/aapm.107659
This article has been retracted. See Retraction Note: The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study.

how to cite: Bahr M H, Rashwan D A E, Kasem S A. Retracted Article: The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study. Anesth Pain Med. 2021;11(1):e107659. https://doi.org/10.5812/aapm.107659.

Abstract

Objectives:

Postoperative cognitive dysfunction (POCD) is multifactorial, which may be caused by anesthetic and surgical causes or cerebral injury. This study aimed to evaluate the effect of dexmedetomidine as a neuroprotective drug compared to esmolol on the prevalence of POCD in adult patients undergoing middle ear surgeries under hypotensive anesthesia.

Methods:

This study included male and female adult patients, according to American Society of Anesthesiology physical status (ASA) I, the patients who underwent middle ear surgeries under hypotensive anesthesia were randomly assigned to two groups that received esmolol and dexmedetomidine. The demographic data, heart rate, mean arterial blood pressure, duration of the surgery, evaluation of the surgical field, and the Mini-Mental State Examination (MMSE) (preoperatively and at 1, 6 and 24 hours postoperatively) were recorded.

Results:

There was a significant difference between the numbers of patients who had POCD in MMSE1: 12 cases in the esmolol group (41.37%) compared to three cases in the dexmedetomidine group (10.34%) (P = 0.016), in MMSE6: 10 cases in the esmolol group (34.48%) compared with two cases in the dexmedetomidine group (6.89%) (P = 0.023) and in MMSE24: seven cases in the esmolol group (24.13%) compared with one case in the dexmedetomidine group (3.44%) (P = 0.022), while the median and range of MMSE score were comparable between the two groups (P > 0.05).

Conclusions:

This study suggests that intraoperative use of dexmedetomidine as an adjuvant to hypotensive anesthesia reduces the incidence of POCD compared to esmolol.

Acknowledgements

References

  • 1.

    Hanning CD. Postoperative cognitive dysfunction. Br J Anaesth. 2005;95(1):82-7. [PubMed ID: 15640305]. https://doi.org/10.1093/bja/aei062.

  • 2.

    Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18-30. [PubMed ID: 18156878]. https://doi.org/10.1097/01.anes.0000296071.19434.1e.

  • 3.

    Canet J, Raeder J, Rasmussen LS, Enlund M, Kuipers HM, Hanning CD, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand. 2003;47(10):1204-10. [PubMed ID: 14616316]. https://doi.org/10.1046/j.1399-6576.2003.00238.x.

  • 4.

    Morgan GE, Mikhail MS, Murray MJ. Hypotensive agents. Morgan & Mikhail's clinical anesthesiology. New Delhi, India: Tata McGraw-Hill; 2012. p. 255-62.

  • 5.

    Guney A, Kaya FN, Yavascaoglu B, Gurbet A, Selmi NH, Kaya S, et al. Comparison of esmolol to nitroglycerine in controlling hypotension during nasal surgery. Eurasian J Med. 2012;44(2):99-105. [PubMed ID: 25610218]. [PubMed Central ID: PMC4261293]. https://doi.org/10.5152/eajm.2012.23.

  • 6.

    Degoute CS. Controlled hypotension: a guide to drug choice. Drugs. 2007;67(7):1053-76. [PubMed ID: 17488147]. https://doi.org/10.2165/00003495-200767070-00007.

  • 7.

    Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. The Lancet. 1998;351(9106):857-61. https://doi.org/10.1016/s0140-6736(97)07382-0.

  • 8.

    Barak M, Yoav L, Abu el-Naaj I. Hypotensive anesthesia versus normotensive anesthesia during major maxillofacial surgery: a review of the literature. ScientificWorldJournal. 2015;2015:480728. [PubMed ID: 25811042]. [PubMed Central ID: PMC4355120]. https://doi.org/10.1155/2015/480728.

  • 9.

    Das A, Chhaule S, Bhattacharya S, Basunia SR, Mitra T, Halder PS, et al. Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study. Saudi J Anaesth. 2016;10(3):276-82. [PubMed ID: 27375381]. [PubMed Central ID: PMC4916810]. https://doi.org/10.4103/1658-354X.174919.

  • 10.

    Celebi N, Artukoglu F, Dal D, Saricaoglu F, Celiker V, Aypar U. Effect of hypotensive anesthesia on cognitive functions. A comparison of esmolol and remifentanil during tympanoplasty. Saudi Med J. 2007;28(9):1357-61. [PubMed ID: 17768460].

  • 11.

    Sharma S, Suthar OP, Tak ML, Thanvi A, Paliwal N, Karnawat R. Comparison of esmolol and dexmedetomidine for suppression of hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing elective general surgery: A prospective, randomized controlled double-blinded study. Anesth Essays Res. 2018;12(1):262-6. [PubMed ID: 29628593]. [PubMed Central ID: PMC5872877]. https://doi.org/10.4103/aer.AER_226_17.

  • 12.

    Ma D, Rajakumaraswamy N, Maze M. alpha2-Adrenoceptor agonists: shedding light on neuroprotection? Br Med Bull. 2004;71:77-92. [PubMed ID: 15684247]. https://doi.org/10.1093/bmb/ldh036.

  • 13.

    Safavynia SA, Goldstein PA. The role of neuroinflammation in postoperative cognitive dysfunction: Moving from hypothesis to treatment. Front Psychiatry. 2018;9:752. [PubMed ID: 30705643]. [PubMed Central ID: PMC6345198]. https://doi.org/10.3389/fpsyt.2018.00752.

  • 14.

    Sato K, Kimura T, Nishikawa T, Tobe Y, Masaki Y. Neuroprotective effects of a combination of dexmedetomidine and hypothermia after incomplete cerebral ischemia in rats. Acta Anaesthesiol Scand. 2010;54(3):377-82. [PubMed ID: 19860751]. https://doi.org/10.1111/j.1399-6576.2009.02139.x.

  • 15.

    Folstein MF, Folstein SE, McHugh PR. ''Mini-mental state". A practical method for grading the cognitive state for the clinician. J Psychiat Res. 1975;12(3):189-98. https://doi.org/10.1016/0022-3956(75)90026-6.

  • 16.

    Niazi AA. Postoperative cognitive function and controlled hypotensive anesthesia in patients undergoing septoplasty. Egypt J Anaesth. 2019;32(1):61-6. https://doi.org/10.1016/j.egja.2015.10.002.

  • 17.

    American Society of Anesthesiologists Task Force on S, Analgesia by N. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004-17. [PubMed ID: 11964611]. https://doi.org/10.1097/00000542-200204000-00031.

  • 18.

    Aldrete J. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91. https://doi.org/10.1016/0952-8180(94)00001-k.

  • 19.

    Williams-Russo P, Sharrock NE, Mattis S, Szatrowski TP, Charlson ME. Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA. 1995;274(1):44-50. [PubMed ID: 7791257].

  • 20.

    Jungwirth B, Zieglgansberger W, Kochs E, Rammes G. Anesthesia and postoperative cognitive dysfunction (POCD). Mini Rev Med Chem. 2009;9(14):1568-79. [PubMed ID: 20088778]. https://doi.org/10.2174/138955709791012229.

  • 21.

    Sanders RD, Xu J, Shu Y, Januszewski A, Halder S, Fidalgo A, et al. Dexmedetomidine attenuates isoflurane-induced neurocognitive impairment in neonatal rats. Anesthesiology. 2009;110(5):1077-85. [PubMed ID: 19352168]. https://doi.org/10.1097/ALN.0b013e31819daedd.

  • 22.

    Goyagi T, Nishikawa T, Tobe Y, Masaki Y. The combined neuroprotective effects of lidocaine and dexmedetomidine after transient forebrain ischemia in rats. Acta Anaesthesiol Scand. 2009;53(9):1176-83. [PubMed ID: 19388884]. https://doi.org/10.1111/j.1399-6576.2009.01976.x.

  • 23.

    Kuhmonen J, Haapalinna A, Sivenius J. Effects of dexmedetomidine after transient and permanent occlusion of the middle cerebral artery in the rat. J Neural Transm (Vienna). 2001;108(3):261-71. [PubMed ID: 11341477]. https://doi.org/10.1007/s007020170071.

  • 24.

    Kuhmonen J, Pokorny J, Miettinen R, Haapalinna A, Jolkkonen J, Riekkinen PS, et al. Neuroprotective effects of dexmedetomidine in the gerbil hippocampus after transient global ischemia. Anesthesiology. 1997;87(2):371-7. [PubMed ID: 9286902]. https://doi.org/10.1097/00000542-199708000-00025.

  • 25.

    Dahmani S, Paris A, Jannier V, Hein L, Rouelle D, Scholz J, et al. Dexmedetomidine increases hippocampal phosphorylated extracellular signal-regulated protein kinase 1 and 2 content by an alpha 2-adrenoceptor-independent mechanism: evidence for the involvement of imidazoline I1 receptors. Anesthesiology. 2008;108(3):457-66. [PubMed ID: 18292683]. https://doi.org/10.1097/ALN.0b013e318164ca81.

  • 26.

    Shen J, Wu Y, Xu JY, Zhang J, Sinclair SH, Yanoff M, et al. ERK- and Akt-dependent neuroprotection by erythropoietin (EPO) against glyoxal-AGEs via modulation of Bcl-xL, Bax, and BAD. Invest Ophthalmol Vis Sci. 2010;51(1):35-46. [PubMed ID: 19628748]. https://doi.org/10.1167/iovs.09-3544.

  • 27.

    Yang W, Kong LS, Zhu XX, Wang RX, Liu Y, Chen LR. Effect of dexmedetomidine on postoperative cognitive dysfunction and inflammation in patients after general anaesthesia: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2019;98(18). e15383. [PubMed ID: 31045788]. [PubMed Central ID: PMC6504304]. https://doi.org/10.1097/MD.0000000000015383.

  • 28.

    Zhang Y, Xing Z, Xu Y, Xu S. Effects of different doses of dexmedetomidine on cognitive dysfunction in elderly patients early after laparoscopic surgery for colorectal cancer. J Int Med Res. 2016;44(6):1182-90. [PubMed ID: 27913743]. [PubMed Central ID: PMC5536774]. https://doi.org/10.1177/0300060516671623.

  • 29.

    Zhou C, Zhu Y, Liu Z, Ruan L. Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis. J Int Med Res. 2016;44(6):1182-90. [PubMed ID: 27913743]. [PubMed Central ID: PMC5536774]. https://doi.org/10.1177/0300060516671623.

  • 30.

    Chen W, Liu B, Zhang F, Xue P, Cui R, Lei W. The effects of dexmedetomidine on post-operative cognitive dysfunction and inflammatory factors in senile patients. Int J Clin Exp Med. 2015;8(3):4601-5. [PubMed ID: 26064392]. [PubMed Central ID: PMC4443226].

  • 31.

    Mohamed S, Shaaban AR. The effect of Dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery. Egypt J Anaesth. 2019;30(4):331-8. https://doi.org/10.1016/j.egja.2014.03.007.

  • 32.

    Sulemanji DS, Donmez A, Aldemir D, Sezgin A, Turkoglu S. Dexmedetomidine during coronary artery bypass grafting surgery: is it neuroprotective?--A preliminary study. Acta Anaesthesiol Scand. 2007;51(8):1093-8. [PubMed ID: 17697305]. https://doi.org/10.1111/j.1399-6576.2007.01377.x.