21. ASSOCIATION BETWEEN MIDAZOLAM AND POSTOPERATIVE COGNITIVE DYSFUNCTION IN ELDERLY PATIENTS FOLLOWING JOINT ARTHROPLASTY

Bui Duc Thanh1, Bui Quoc Khanh1
1 175 Military Hospital

Main Article Content

Abstract

Background: Postoperative cognitive dysfunction greatly affects the quality of recovery after
surgery, especially in the elderly, prolonging hospital stay. To reduce anxiety and stress for patients
who are anesthetized with spinal anesthesia using sedation. Therefore, we hypothesized that the use
of midazolam sedation during surgery is related to postoperative cognitive dysfunction in elderly
patients following joint arthroplasty.


Objective: Determine the relationship between midazolam and cognitive disorders after joint
replacement surgery in the elderly.


Materials and Methods: Elderly patients (≥ 60 years) receiving spinal anesthesia for joint
arthroplasty. Design of this study is longitudinal observational, prospective, single-center.


Results: 22,5% of elderly patients had postoperative cognitive dysfunction for joint arthroplasty and
received spinal anesthesia in the first 5 days of surgery. Elderly patients with postoperative cognitive
dysfunction have a longer postoperative treatment (p < 0.05). Multivariable Cox regression analysis
noted that using of sedative midazolam during surgery (p=0,002) was a risk factor for postoperative
cognitive dysfunction.


Conclusions: Of all the 107 patients, we noted that elderly patients with postoperative cognitive
dysfunction have a longer postoperative treatment. The use of sedative midazolam during surgery is
a risk factor for postoperative cognitive dysfunction.

Article Details

References

[1] Moller J, Cluitmans P, Rasmussen L et al.,
Longterm postoperative cognitive dysfunction in the
elderly: ISPOCD1 study. The Lancet. 1998;
351(9106):857-861.
[2] Bekker AY, Weeks EJ, Cognitive function after
anaesthesia in the elderly. Best Practice &
Research Clinical Anaesthesiology.
2003;17(2):259-272.
[3] Steinmetz J, Christensen KB, Lund T et al.,
Long-term consequences of postoperative
cognitive dysfunction. Anesthesiology: The
Journal of the American Society of
Anesthesiologists. 2009;110(3):548-555.
[4] Monk TG, Weldon BC, Garvan CW et al.,
Predictors of cognitive dysfunction after major
noncardiac surgery. Anesthesiology-philadelphia
then hagerstown. 2008;108(1):18.
[5] Li WX, Luo RY, Chen C et al., Effects of propofol,
dexmedetomidine, and midazolam on
postoperative cognitive dysfunction in elderly
patients: a randomized controlled preliminary trial.
Chin Med J (Engl). Feb 2019;132(4):437-445.
[6] Zhu SH, Ji MH, Gao DP et al., Association
between perioperative blood transfusion and
early postoperative cognitive dysfunction in aged
patients following total hip replacement surgery.
Ups J Med Sci. Aug 2014;119(3):262-7.
[7] Zhang H, Zheng J, Wang R et al., Serum
Phosphorylated Neurofilament Heavy SubunitH,
a Potential Predictive Biomarker for
Postoperative Cognitive Dysfunction in Elderly
Subjects Undergoing Hip Joint Arthroplasty. J
Arthroplasty. Aug 2019; 34(8):1602-1605.
[8] Gao B, Zhu B, Wu C, Preoperative Serum 25-
Hydroxyvitamin D Level, a Risk Factor for
Postoperative Cognitive Dysfunction in Elderly
Subjects Undergoing Total Joint Arthroplasty.
Am J Med Sci. Jan 2019;357(1):37-42.
doi:10.1016/j.amjms.2018.10.012
[9] Picton JD, Marino AB, Nealy KL,
Benzodiazepine use and cognitive decline in the
elderly. Am J Health Syst Pharm. Jan 1
2018;75(1):e6-e12. doi:10.2146/ajhp160381
[10] Veering B, Dodds C, Anaesthesia in the elderly.
In: Hopkins PM, Hardman JG, Hopkins PM,
Struys MMRF, eds. Oxford Textbook of
Anaesthesia. Oxford University Press; 2017.