Effects of Single Low Dose of Dexamethasone before Noncardiac and Nonneurologic Surgery and General Anesthesia on Postoperative Cognitive Dysfunction-A Phase III Double Blind, Randomized Clinical Trial

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Sanches Valentin, Livia Stocco ^[1] ; Angelim Pereira, Valeria Fontenelle ^[1] ; Pietrobon, Ricardo S. ^[2] ; Schmidt, Andre P. ^{[3, 4]} ; Oses, Jean P. ^[5] ; Portela, Luis V. ^[3] ; Souza, Diogo O. ^[3] ; Nickenig Vissoci, Joao Ricardo ^{[2, 6]} ; da Luz, Vinicius Fernando ^[1] ; de Araujo de Souza Trintoni, Leticia Maria ^[1] ; Nielsen, Karen C. ^[7] ; Carvalho Carmona, Maria Jose ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Dept Anesthesia, LIM Lab Anesthesiol 8, Sao Paulo, SP - Brazil

^[2] Duke Univ Hlth Syst, Dept Surg, Durham, NC - USA

^[3] Univ Fed Rio Grande do Sul, Dept Biochem, Porto Alegre, RS - Brazil

^[4] Hosp Porto Alegre, Dept Anesthesia & Perioperat Med, Porto Alegre, RS - Brazil

^[5] Univ Catolica Pelotas, Ctr Sci Life & Hlth, Pelotas, RS - Brazil

^[6] Fac Inga, Dept Med, Maringa, Parana - Brazil

^[7] Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 - USA

• Tipo de documento: Artigo Científico
• Fonte: PLoS One; v. 11, n. 5 MAY 6 2016.
• Citações Web of Science: 8

Resumo

Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35-45 or 46-55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100 beta was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant. RESULTS: On the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35-45, and BIS 46-55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35-45 and BIS 46-55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46-55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100 beta serum levels. CONCLUSION: Dexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46-55. The effect of dexamethasone on S100 beta might be related with some degree of neuroprotection. (AU)

• Processo FAPESP: 09/54233-0 - Disfunção cognitiva após cirurgia sob anestesia geral
• Beneficiário: Maria José Carvalho Carmona
• Modalidade de apoio: Auxílio à Pesquisa - Regular