Effects of dexmedetomidine combined with etomidate on perioperative neurocognitive disorder in elderly patients undergoing orthopedic surgery
MU Jiaxin
LI Fange
YANG Xiaoming
LIU Jun
TAO Tianzhu
XU Yuhai
CAO Yuxuan
JI Jun
MA Yujie
Abstract：Objective To investigate the effect of dexmedetomidine combined with etomidate on the incidence of perioperative neurocognitive disorder(PND)and hemodynamics in elderly orthopedic surgery patients.Methods Elderly patients ages 60 to 90 and undergoing elective orthopedic general anesthesia surgery at the Air Force Medical Centre between June 2022 and August 2023 were selected as the subjects,and randomly divided into the propofol group,etomidate group,and the dexmedetomidine combined with etomidate group(the combined group)using the random number table method.Neurocognitive function tests were performed on the 1st preoperative day,the 1st postoperative day and the 3rd postoperative day.The indexes of intraoperative heart rate,mean arterial pressure and depth of anesthesia changes were recorded and compared between these groups.Contributors to PND on postoperative days 1 and 3 were analyzed using univariate analysis and multifactorial logistic regression.Results A total of 208 patients were included in the study,with 69 in the propofol group,69 in the etomidate group,and 70 in the combined group.There was no statistically significant difference between the three groups of patients in terms of age,body mass index,and gender(all P＞0.05).The results of repeated measures ANOVA show that,the heart rate of the etomidate group was higher than that of the combined group,and the difference was statistically significant(P=0.007).The incidence rates of PND on the 1st and 3rd postoperative days in the combined group were both lower than those of the propofol group and the etomidate group,and the differences were of statistical significance(all P＜0.05).Multivariate logistic regression analysis indicated that the combination medication was a protective factor against PND on the 1st postoperative day(OR=0.388,95％CI:0.173-0.869).A preoperative history of diabetes(OR=3.765,95％CI:1.533-9.245),a pre-frail status(OR=8.877,95％CI:1.082-72.811),and a semi-sitting surgical position(OR=6.901,95％CI:1.035-45.995)were risk factors for PND on the 3rd postoperative day.The combination medication(OR=0.272,95％CI:0.090-0.824)and a higher preoperative Mini-Mental State Examination score(OR=0.754,95％CI:0.595-0.957)were protective factors against PND on the 3rd postoperative day.Conclusion Intravenous anesthesia with dexmedetomidine combined with etomidate can reduce the incidence of PND and effectively improve the quality of life of elderly patients undergoing orthopedic surgery.Intravenous anesthesia with etomidate can increase heart rate compared with the combination of dexmedetomidine and etomidate,but has less impact on circulation,suggesting that intravenous anesthetic drugs should be selected according to the patient's circulation and surgical needs.
Keywords：Perioperative neurocognitive disorderDexmedetomidineEtomidateElderly patients
Publication Date：2025-12-25
Online Publishing Date：2026-03-31(First online date of this platform, not the publication date of the document)
Pages：7( 582-588 )