Influence of Neostigmine on Early Postoperative Cognitive Dysfunction in Older Adult Patients Undergoing Noncardiac Surgery: A Double-Blind, Placebo-Controlled, Randomized Controlled Trial
Chengcheng Deng, Lin Yang, Defeng Sun, Yan Feng, Zhongliang Sun, Junjie Li- Anesthesiology and Pain Medicine
BACKGROUND:
The goal of this study was to investigate the efficacy of neostigmine on postoperative cognitive dysfunction (POCD) and determine its effect on systematic markers of oxidative stress in older patients.
METHODS:
This double-blind placebo-controlled trial enrolled 118 elderly patients (≥65 years) undergoing noncardiac surgeries who were allocated to a neostigmine treatment group (0.04 mg/kg) or a placebo control group (normal saline) postoperatively. POCD was diagnosed if the
RESULTS:
Patients receiving neostigmine had a significantly reduced incidence of POCD compared to patients who were treated with placebo on the first day after surgery (−22%, 95% confidence interval [CI], −37 to −7), but not on the third (8%, 95% CI, −4 to 20) or seventh day after surgery (3%, 95% CI, −7 to 13). Postoperative plasma MDA levels were significantly lower (
CONCLUSIONS:
Neostigmine reduced POCD on the first day after noncardiac surgery in older patients. Neostigmine treatment inhibited oxidative stress and increased serum BDNF levels. There was no significant influence of neostigmine on POCD on the third or seventh day after surgery. The clinical influence of neostigmine on POCD should be further investigated.