Higher dose dexamethasone increases early postoperative cognitive dysfunction.

Area of Science:

• Anesthesiology
• Neurosurgery
• Pharmacology

Background:

• Postoperative cognitive dysfunction (POCD) is a significant concern after surgery.
• Dexamethasone is a corticosteroid sometimes used perioperatively.
• The impact of dexamethasone dosage on early POCD after microvascular decompression (MVD) requires investigation.

Purpose of the Study:

• To evaluate the effect of different intravenous dexamethasone doses on early postoperative cognitive dysfunction (POCD).
• To determine if dexamethasone administration influences the incidence of POCD following microvascular decompression (MVD).

Main Methods:

• A prospective randomized trial involving 1000 patients undergoing MVD for facial spasm.
• Patients were assigned to receive normal saline, 0.1 mg/kg dexamethasone, or 0.2 mg/kg dexamethasone.
• Neuropsychological tests were administered preoperatively and on postoperative day 5 to assess POCD.

Main Results:

• POCD occurred in 22.3% of the control group, 20.6% in the 0.1 mg/kg dexamethasone group, and 31.4% in the 0.2 mg/kg dexamethasone group.
• A statistically significant difference in POCD incidence was observed among the groups (P=0.003).
• The 0.2 mg/kg dexamethasone group showed a significantly higher incidence of POCD compared to both the control and 0.1 mg/kg groups.

Conclusions:

• Intravenous administration of a higher dose of dexamethasone (0.2 mg/kg) is associated with an increased incidence of early POCD.
• Lower doses of dexamethasone (0.1 mg/kg) did not significantly increase early POCD compared to the control group.
• Careful consideration of dexamethasone dosage is warranted in patients undergoing MVD to mitigate the risk of early cognitive dysfunction.