Sedative and Cerebral Protection Effects of Midazolam,Dexmedetomidine and Propofol in Elderly Patients After Cardiac Surgery

YAN Mi; MA Junqi; WANG Yanxin

doi:10.3969/j.issn.1004-437X.2025.20.013

Abstract：Objective To explore the sedative and cerebral protection effects of midazolam,dexmedetomidine and propofol in elderly patients after cardiac surgery.Methods A total of 98 elderly patients undergoing coronary bypass heart surgery in the hospital were enrolled between May 2021 and May 2023.According to different intraoperative anesthetics,they were divided into midazolam group(32 cases),dexmedetomidine group(32 cases)and propofol group(34 cases).On basis of morphine as the basic analgesia,the three groups were given midazolam,dexmedetomidine and propofol,respectively.The surgical indexes(operation time,awaking time,times of motor responses,recovery time of orientation),sedation,hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)]and cerebral oxygen metabolism indexes[cerebral arterio-venous oxygen content difference(Da-jvO2),cerebral oxygen extraction rate(CERO2)]immediately after entering operating room(T0),consciousness disappearance(T,)and surgery(T2),pain level[visual analogue scale(VAS)]at 12 h,24 h and 48 h after surgery,cognitive function[mini-mental state examination(MMSE)]at 12 h before surgery and at 12 h,24 h and 48h after surgery,and adverse reactions at 24 h after surgery were compared among the three groups.Results The awaking time and recovery time of orientation,and times of motor responses at T,and T2 were increased in dexmedetomidine group,midazolam group and propofol group successively(P＜0.05).At T,and T2,HR and MAP were increased in dexmedetomidine group,midazolam group and propofol group successively.The sedative time and mechanical ventilation were prolonged in dexmedetomidine group,midazolam group and propofol group successively(P＜0.05).At T,and T2,Da-jvO2 and CERO2 were increased in dexmedetomidine group,midazolam group and propofol group successively(P＜0.05).At 12 h,24 h and 48 h after surgery,VAS scores were increased,while MMSE scores were decreased in dexmedetomidine group,midazolam group and propofol group successively(P＜0.05).At 24 h after surgery,there was 1 case with headache and 1 case with gastrointestinal reactions in midazolam group,there was 1 case with gastrointestinal reactions in dexmedetomidine group,and there were 2 cases with headache in propofol group.There was no difference in adverse anesthesia reactions among the three groups(x2=0.388,P＞0.05).Conclusion Midazolam,dexmedetomidine and propofol all have sedative effect in elderly patients after cardiac surgery.However,dexmedetomidine has more significant sedative effect,which is more beneficial to protect brain tissues.