Effects of Dexmedetomidine General Anesthesia and Epidural Anesthesia on Cognitive Function in Patients Undergoing Ureteroscopy for Ureteral Stone Removal

doi:10.3969/j.issn.1674-3245.2025.03.047

Abstract：Objective To investigate the effects of dexmedetomidine general anesthesia and epidural anesthesia on cognitive function in patients undergoing ureteroscopy for ureteral stone removal (URL). Methods A total of 200 patients who underwent URL at The Affiliated Fuxing Hospital, Capital Medical University from January 2018 to January 2024 were retrospectively selected. Patients were divided into two groups based on the anesthetic method: the dexmedetomidine group (n=110) and the epidural anesthesia group (n=90). Patients in the dexmedetomidine group received intravenous infusion of dexmedetomidine injection, while those in the epidural anesthesia group received combined spinal-epidural anesthesia at the L3-4 or L2-3 intervertebral space. Hemodynamics, cognitive function, and adverse reactions were compared between the two groups. Results After surgery, the systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) of the epidural anesthesia group were significantly higher than those of the dexmedetomidine group (t=5.842, 5.982, 12.192, P<0.05). Additionally, the neutrophil count and high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher in the epidural anesthesia group than in the dexmedetomidine group (t=10.204, 3.759, P<0.05). There was no significant difference in the visual analog scale (VAS) score between the two groups at T3 (P>0.05). However, the VAS scores at T6 and T16 were significantly higher in the epidural anesthesia group than in the dexmedetomidine group, while the VAS score at T24 was significantly lower (t=5.816, 7.776, 10.56, P<0.05). The Ramsay sedation scale (RSS) scores of the epidural anesthesia group were lower than those of the dexmedetomidine group at all time points from T3 to T24 (t=18.534, 23.228, 41.463, 52.590, P<0.05). The mini-mental state examination (MMSE) scores of the epidural anesthesia group were higher than those of the dexmedetomidine group at all time points (t=7.565, 5.376, 7.556, 6.560, P<0.05). The total incidence of adverse events in the epidural anesthesia group was 5.56%, which was significantly lower than that in the dexmedetomidine group (χ²=4.955, P=0.026). Conclusion Both dexmedetomidine general anesthesia and epidural anesthesia have their own advantages in URL. In terms of cognitive function, epidural anesthesia can reduce systemic drug exposure and achieve precise analgesia, offering better cognitive protection.