Comparison of the Effects of Dexmedetomidine and Lidocaine on Stress Response and Postoperative Delirium of Older Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial

作者全名："Lai, Yuan; Chen, Qi; Xiang, Chunfang; Li, Guanzhu; Wei, Ke"

作者地址："[Lai, Yuan; Chen, Qi; Wei, Ke] Chongqing Med Univ, Clin Coll 1, Dept Anesthesiol, Chongqing, Peoples R China; [Lai, Yuan] Chongqing Three Gorges Med Coll, Affiliated Peoples Hosp, Dept Anesthesiol, Chongqing, Peoples R China; [Chen, Qi] Chongqing Univ, Canc Hosp, Dept Anesthesiol, Chongqing, Peoples R China; [Xiang, Chunfang] Chongqing Univ, Three Gorges Hosp, Dept Thorac Surg, Chongqing, Peoples R China; [Li, Guanzhu] Guangzhou Univ Chinese Med, Guangdong Hosp Tradit Chinese Med, Affiliated Hosp 2, Dept Anesthesiol, Guangzhou, Peoples R China; [Wei, Ke] Youyi Rd, Chongqing 400042, Peoples R China"

通信作者："Wei, K (通讯作者)，Youyi Rd, Chongqing 400042, Peoples R China."

来源：CLINICAL INTERVENTIONS IN AGING

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001046329100001

JCR分区：Q2

影响因子：3.5

年份：2023

卷号：18

期号：　

开始页：1275

结束页：1283

文献类型：Article

关键词：lidocaine; dexmedetomidine; inflammation; delirium; thoracoscopic surgery; elderly

摘要："Purpose: We investigated the effects of intraoperative intravenous lidocaine or dexmedetomidine infusion on inflammatory factors and cognitive function in patients undergoing thoracoscopic surgery. Patients and Methods: Patients aged >65 years undergoing elective thoracoscopic lobectomy or segmentectomy were randomly grouped as dexmedetomidine group (group D), lidocaine group (group L), and control group (group C). The plasma cortisol, interleukin-6, and tumor necrosis factor-& alpha; concentrations were measured before anesthesia (T0) and immediately (T1), 24 h (T2), and 48 h postoperatively (T3). Postoperative delirium (POD) was assessed by 3D-CAM on days 2 and 7. Results: The cortisol concentrations decreased for all groups at T1 from T0 although they were significantly higher at T2. Group L had significantly lower interleukin-6 concentrations at T1 and T2 than the other groups (P<0.05). The interleukin-6 concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups, significantly lower for groups D and L than for group C at T1 and T2 (P<0.05), and significantly lower for group L than for group D at T2 (P<0.05). The tumor necrosis factor-& alpha; concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups and significantly lower for groups D and L than for group C at T1 and T2 (P<0.05), although they were not statistically significantly different for groups D and L. There were no statistically significant differences in the postoperative incidence of POD between the three groups on days 2 and day 7. Conclusion: Intraoperative continuous intravenous lidocaine or dexmedetomidine infusion reduced surgical stress and inflammatory responses. The inhibitory effect of lidocaine on surgical stress remained significant for up to 24 h postoperatively without affecting patient awakening. However, the administration of either drug failed to prevent postoperative POD."

基金机构：Chongqing Health Commission [2021MSXM146]; Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) [2023MSXM125]; Scientific and Technological Research Program of Chongqing Municipal Education Commission [KJQN202202721]

基金资助正文：The present work was supported by grants from Chongqing Health Commission (project no. 2021MSXM146) and Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau 2023MSXM125) and Scientific and Technological Research Program of Chongqing Municipal Education Commission (KJQN202202721) .