Dexmedetomidine, recognized for its neuroprotective properties, is believed to reduce perioperative delirium. This central alpha-2 adrenoreceptor agonist functions by acting at the locus coeruleus to induce sedation and provide opioid-sparing analgesia, while also causing bradycardia and hypotension through its sympatholytic action. It facilitates a type of sleep that mirrors natural sleep without adversely affecting respiratory function. The potential mechanisms through which dexmedetomidine may reduce postoperative cognitive dysfunction (POCD) include the inhibition of inflammation, provision of analgesia, and protection of the central nervous system (CNS).
A meta-analysis encompassing seven studies that incorporated dexmedetomidine into general anesthesia found a significant reduction in POCD on Day 7 postoperatively within the treatment group, with an odds ratio of 0.34 and a 95% confidence interval from 0.19 to 0.61, indicating a statistically significant result (p<0.001). However, the randomized controlled trials (RCTs) involved in this analysis only used the Mini-Mental State Examination (MMSE) postoperatively without any baseline cognitive assessments. This limitation diminishes the reliability of the association between dexmedetomidine use and reduced POCD.
