Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial

Figures & data

Figure 1 Consolidated Standards of Reporting Trials diagram. A patient flow diagram is shown. Group C, Control group; Group D, Dexmedetomidine group.

Table 1 Patient Characteristics Between the Two Groups

Factors	Control (N=149)	Dexmedetomidine (N=150)	P
Age (year) Mean±SD	70.1 ± 4.2	70.4 ± 5.0	0.622
Tumor stage			0.012
Lower tumor stage (I&II)	97 (65.1)	76 (50.7)
Higher tumor stage (III&IV)	52 (34.9)	74 (49.3)
Educational level			0.321
High (greater than high school degree), no. (%)	38 (25.5)	46 (30.7)
Low (middle school and elementary school), no. (%)	111 (74.5)	104 (69.3)
MMSE, Mean ± SD	23.9 ± 4.9	24.3 ± 4.8	0.389
CIRs, Mean ± SD	5.1 ± 2.3	5.0 ± 2.2	0.676
Previous cerebral stroke			0.093
Yes, no. (%)	21 (14.1)	12 (8.0)
No, no. (%)	128 (85.9)	138 (92.0)
Poor sleep quality			0.770
Yes, no. (%)	44 (29.5)	42 (28.0)
No, no. (%)	105 (70.5)	108 (72.0)
Hypertension			0.272
Yes, no. (%)	77 (51.7)	68 (45.3)
No, no. (%)	72 (48.3)	82 (54.7)
Diabetes mellitus			0.899
Yes, no. (%)	25 (16.8)	26 (17.3)
No, no. (%)	124 (83.2)	124 (82.7)
Alcohol abuse			0.657
Yes, no. (%)	99 (66.4)	96 (64.0)
No, no. (%)	50 (33.6)	54 (36.0)
Current Smoker			0.491
Yes, no. (%)	133 (89.3)	130 (86.7)
No, no. (%)	16 (10.7)	20 (13.3)
Family history of dementia			0.723^†
Yes, no. (%)	4 (2.7)	3 (2.0)
No, no. (%)	145 (97.3)	147 (9.0)
Intraoperative hypotension			0.015
Yes, no. (%)	26 (17.4)	44 (29.3)
No, no. (%)	123 (82.6)	106 (70.7)
Use of sufentanil (μg), Mean ± SD	30.6 ± 8.7	27.1 ± 8.3	<0.001
Surgery duration (min), Median (IQR)	175 (112, 283)	194 (123, 296)	0.350
Anesthesia duration (min), Median (IQR)	223 (130, 298)	233 (124, 286)	0.498
Recovery time (min), Median (IQR)	38 (32, 45)	39 (30, 43)	0.168
Hospital stay (day), Median (IQR)	13 (10, 15)	13 (9, 15)	0.785

Notes: †, Fisher's exact test.

Abbreviations: MMSE, Mini-Mental State Examination; CIRs, Cumulative Illness Rating Scale; SD, standard deviation; IQR, interquartile range.

Table 2 Incidence of POD Between Two Groups

Factors	Control	Dexmedetomidine	OR (95% CI)	P
Over-all POD	N=149	N=150	0.851 (0.493–1.453)	0.560
Yes, no. (%)	36 (24.2)	32 (21.3)
No, no. (%)	113 (32.1)	118 (78.7)
POD in patients with lower tumor stage (I& II)	N=97	N=76	1.350 (0.610–2.987)	0.444
Yes, no. (%)	16 (16.5)	16 (21.1)
No, no. (%)	81 (83.5)	60 (78.9)
POD in patients with higher tumor stage (III& IV)	N=52	N=74	0.441 (0.209–0.979)	0.039
Yes, no. (%)	20 (38.5)	16 (21.6)
No, no. (%)	32 (61.5)	58 (78.4)

Abbreviations: POD, postoperative delirium; OR, odd ratio.

Table 3 Patient Characteristics Between the Two Groups of Blood Sampling

Factors	Control (N=80)	Dexmedetomidine (N=80)	P value
Age (year), Mean±SD	67.4 ± 5.5	67.7 ± 5.7	0.685
Higher tumor stage, n(%)	25 (31.3%)	35 (43.8%)	0.103
Low educational level, n(%)	56 (70%)	55 (68.8%)	>0.999
MMSE, median (IQR)	26 (21, 28)	25 (22, 28)	0.941
CIRs, median (IQR)	4 (4,7)	4 (4,6)	0.392
Presence of previous cerebral stroke, n(%)	12 (15.0)	7 (8.8%)	0.329
Presence of hypertension, n(%)	36 (45)	35 (43.8)	>0.999
Presence of diabetes mellitus, n(%)	17 (21.3)	15 (18.8)	0.844
Presence of alcohol abuse, n(%)	19 (23.8)	26 (32.5)	0.291
Presence of current smoker	10 (12.5)	11 (13.8)	>0.999
Intraoperative hypotension, n(%)	11 (13.8)	25 (31.3)	0.013
Use of sufentanil (μg), Mean ± SD	30.6 ± 9.7	26.0 ± 7.4	0.001
Surgery duration(min), median (IQR)	191 (107.3, 317.0)	197 (122.2, 298.5)	0.968
Anesthesia duration (min), Median (IQR)	224 (120, 311)	228 (138, 295)	0.850
Recovery time (min), Median (IQR)	37 (30, 43)	39 (31, 44)	0.293
POD, n(%)	16 (20%)	18 (22.5)	0.847

Abbreviations: MMSE, Mini-Mental State Examination; CIRs, Cumulative Illness Rating Scale; POD, postoperative delirium; SD, standard deviation; IQR, interquartile range.

Figure 2 The change in serum inflammation factors CRP (A) and IL-6 (B) at three timepoints. Group 0=Control group, Group 1=Dexmedetomidine group; Time 1=baseline, Time 2=postoperative day 1, Time 3=postoperative day 3.