Clinical Interventions in Aging (Aug 2023)
Comparison of the Effects of Dexmedetomidine and Lidocaine on Stress Response and Postoperative Delirium of Older Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial
Abstract
Yuan Lai,1,2,* Qi Chen,1,3,* Chunfang Xiang,4 Guanzhu Li,5 Ke Wei1 1Department of Anesthesiology, First Clinical College of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Anesthesiology, Affiliated People’s Hospital of Chongqing Three Gorges Medical College, Chongqing, People’s Republic of China; 3Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China; 4Department of Thoracic Surgery, Chongqing University Three Gorges Hospital, Chongqing, People’s Republic of China; 5Department of Anesthesiology, Guangdong Hospital of Traditional Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ke Wei, Youyi Road, Yuzhong District, Chongqing, 400042, People’s Republic of China, Tel +86 15902360621, Email [email protected]: 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-α 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-α 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.Keywords: lidocaine, dexmedetomidine, inflammation, delirium, thoracoscopic surgery, elderly
