Dexmedetomidine and Delirium in Elderly Patients

Study Overview
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Brief Summary
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Investigators investigates the effect of perioperative dexmedetomidine 0.5 ug/kg/hr followed by a postoperative continuous infusion fentanyl-based PCA(Patient-Controlled Analgesia) drug mixed with dexmedetomidine 0.2ug/kg/hr for two days on reducing postoperative delirium and postoperative rescue analgesics in elderly patients who undergo hip surgery. The other half of patients received fentanyl-based PCA only.

Detailed Description
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Elderly patients are susceptible to postoperative delirium. Delirium occurs in 10 60% and is associated with longer hospital stays, increased costs, and morbidity. Postoperative delirium usually occurs 2 3 days after surgery. Intraoperative infusion of dexmedetomidine lacks preventing postoperative delirium in elderly noncardiac major surgery. We hypothesized postoperative dexmedetomidine for two days as a mixture drug of fentanyl-based PCA could reduce the incidence of postoperative delirium. We compared this effect with other control group who received fentanyl-based PCA only. We also investigate EEG patterns of patients during emergence and compared the EEG patterns who developed delirium postoperatively in PACU(Postanesthesia care unit) or general ward. Dexmedetomidine has analgesic effect. We expected postoperative dexmedetomidine has benefits of opioid sparing effects.

Official Title
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Effect of Dexmedetomidine in Postoperative Delirium in Hip Surgery

Conditions
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Delirium, Dexmedetomidine, Postoperative PCA

Intervention / Treatment
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* Drug: Dexmedetomidine
* Drug: Fentanyl-based PCA infusion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: over 65 yrs old elderly patient who undergo elective hip surgery and ASA(The American Society of Anesthesiologists) physical status I-III Exclusion Criteria: history of dementia, drug abuser, hypersensitivity to dexmedetomidine, fentanyl, propofol, disable to speech, reject the clinical study, hemodynamic instability during surgery, an illiterate, pregnancy

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: randomized control
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: dexmedetomidine group<br>dexmedetomidine mixture with fentanyl-based PCA infusion for 2 days | Drug: Dexmedetomidine<br>* dexmedetomidine 0.5 micg/kg/hr infusion during operation and followed by 0.2 mic/kg/hr with fentanyl-based PCA mixture for 2 days<br>Drug: Fentanyl-based PCA infusion<br>* Fentanyl-based PCA infusion<br>|
| Placebo Comparator: control group<br>Fentanyl-based PCA infusion for 2 days | Drug: Fentanyl-based PCA infusion<br>* Fentanyl-based PCA infusion<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| delirium | reduction of incidence of delirium | 2 days |