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08 - 06 - 2018

Avoiding post-operative delirium

A study in humans and murine models in vitro and in vivo confirms the interest of dexmedetomidine in the prevention of postoperative delirium.

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Acute post-operative delirium is frequently observed in the elderly after surgery. It increases the mortality related to interventions.

 

General anesthetics increase the activity of GABA alpha receptors resulting in reduced excitability of neurons and causes sedation and loss of consciousness. But long after the elimination of the anesthetic agents, this increase in GABA activity continues in a subtle but continuous way in brain areas related to memory and problem solving.

 

Dexmedetomidine, a sedative, is used to reduce postoperative delirium but we don’t know its mode of action. The researchers wanted to know how this effect appears and whether it interferes with GABA activity. This is important to decide whether to extend or reduce the use of the product.

 

For this, they studied two anesthetics (etomidate and sevoflurane) on different models: mouse neurons, astrocytes (neuron support cells) of mice and humans, brain tissues of mice and live mice.

 

They observed that dexmedetomidine resulted after anesthesia in:

       a reduction in the expression of GABA alpha receptors

       an increase in the production of stimulatory neurotrophic factors by astrocytes

       - a decrease in cognitive and memory disorders.

 

The study confirms the interest of dexmedetomidine in the prevention of postoperative delusions and encourages the search for other substances with comparable effect, less expensive and with fewer side effects (blood pressure, heart rate).

 

https://www.asahq.org/about-asa/newsroom/news-releases/2018/06/understanding-how-drug-reduces-confusion-in-older-patients

https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2684546