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已发表论文
术前鼻内给予右美托咪定对患有睡眠障碍的老年患者行非心脏大手术术后谵妄的预防效果：一项随机、三盲、安慰剂对照试验
Authors Chen C, Zhai R, Yang S, Xiong X, Lu J, Tang G, Tang S, Shi Y, Zhu Z , Chen D, Shi J
Received 7 August 2025
Accepted for publication 29 November 2025
Published 6 December 2025 Volume 2025:19 Pages 10821—10834
DOI https://doi.org/10.2147/DDDT.S559012
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Yan Zhu
Chao Chen,1,2,* Ruixue Zhai,1,2,* Shengfeng Yang,3,* Xinglong Xiong,1,2 Jun Lu,1,2 Guangling Tang,1,2 Sijie Tang,1,2 Yewei Shi,1,2 Zhenyan Zhu,1,2 Dongxu Chen,4 Jing Shi1,2
1Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 2School of Anesthesiology, Guizhou Medical University, Guiyang, People’s Republic of China; 3Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 4Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jing Shi, Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, No. 28, Guiyi Street, Guiyang, 550004, People’s Republic of China, Tel +86 18685034016, Email shijing81@gmc.edu.cn
Purpose: Postoperative delirium (POD) is frequent and consequential in older adults, especially those with preexisting sleep disorders. While perioperative intravenous dexmedetomidine may lower POD risk, the benefit of preoperative intranasal administration is unknown. This study aimed to determine whether preoperative intranasal dexmedetomidine reduces POD in elderly patients with sleep disorders undergoing major noncardiac surgery.
Patients and Methods: In this randomized, triple-blind, placebo-controlled trial, 348 elderly patients (≥ 60 years) with a Pittsburgh Sleep Quality Index > 7 undergoing major noncardiac surgery were enrolled between November 2023 and August 2024. Participants received either intranasal dexmedetomidine (n=174) or placebo (n=174) the night before surgery (20:30– 00:00). Dexmedetomidine was administered using a weight-based regimen (≤ 45 kg: 45 μg; 45– 75 kg: 60 μg; ≥ 75 kg: 75 μg), with a rescue dose of 30 μg allowed if sleep onset did not occur within 30 minutes. The primary outcome was the incidence of POD within 5 days postoperatively. Secondary outcomes included preoperative sleep quality, delayed neurocognitive recovery (dNCR) at 7 and 30 days postoperatively, and adverse events on the night before surgery.
Results: The incidence of POD was significantly lower in the dexmedetomidine group than in the placebo group (18.4% vs 32.8%, RR:0.56, 95% CI:0.38– 0.82, P=0.002). Preoperative dexmedetomidine also improved sleep quality on the night before surgery, including total sleep time (6.2± 1.5 hours vs 5.3± 1.7 hours, mean difference:0.89, 95% CI:0.56– 1.23, P< 0.001), sleep efficiency (77.3%± 16.0% vs 66.3%± 19.1%, mean difference:11.01%, 95% CI:7.3%-14.7%, P< 0.001), and subjective sleep quality as assessed by the Richards-Campbell Sleep Questionnaire (68 ± 13 vs 59 ± 15, mean difference:9.31, 95% CI:6.35– 12.27, P< 0.001). There was no between-group difference in dNCR at day 7 or day 30 (both P > 0.05). Dexmedetomidine was associated with a higher incidence of bradycardia during the preoperative night (37.9% vs 16.7%; RR:2.28, 95% CI:1.55– 3.34, P < 0.001), while the incidence of other adverse events was similar between groups (all P > 0.05).
Conclusion: Preoperative intranasal dexmedetomidine reduced the incidence of POD and enhanced preoperative sleep quality in elderly patients with sleep disorders undergoing major noncardiac surgery. Given the increased risk of bradycardia, these benefits should be weighed against the need for perioperative monitoring.
Keywords: geriatric anesthesia, sleep quality, neurocognitive disorders, delirium prevention, alpha-2 adrenergic agonists
1Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 2School of Anesthesiology, Guizhou Medical University, Guiyang, People’s Republic of China; 3Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 4Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jing Shi, Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, No. 28, Guiyi Street, Guiyang, 550004, People’s Republic of China, Tel +86 18685034016, Email shijing81@gmc.edu.cn
Purpose: Postoperative delirium (POD) is frequent and consequential in older adults, especially those with preexisting sleep disorders. While perioperative intravenous dexmedetomidine may lower POD risk, the benefit of preoperative intranasal administration is unknown. This study aimed to determine whether preoperative intranasal dexmedetomidine reduces POD in elderly patients with sleep disorders undergoing major noncardiac surgery.
Patients and Methods: In this randomized, triple-blind, placebo-controlled trial, 348 elderly patients (≥ 60 years) with a Pittsburgh Sleep Quality Index > 7 undergoing major noncardiac surgery were enrolled between November 2023 and August 2024. Participants received either intranasal dexmedetomidine (n=174) or placebo (n=174) the night before surgery (20:30– 00:00). Dexmedetomidine was administered using a weight-based regimen (≤ 45 kg: 45 μg; 45– 75 kg: 60 μg; ≥ 75 kg: 75 μg), with a rescue dose of 30 μg allowed if sleep onset did not occur within 30 minutes. The primary outcome was the incidence of POD within 5 days postoperatively. Secondary outcomes included preoperative sleep quality, delayed neurocognitive recovery (dNCR) at 7 and 30 days postoperatively, and adverse events on the night before surgery.
Results: The incidence of POD was significantly lower in the dexmedetomidine group than in the placebo group (18.4% vs 32.8%, RR:0.56, 95% CI:0.38– 0.82, P=0.002). Preoperative dexmedetomidine also improved sleep quality on the night before surgery, including total sleep time (6.2± 1.5 hours vs 5.3± 1.7 hours, mean difference:0.89, 95% CI:0.56– 1.23, P< 0.001), sleep efficiency (77.3%± 16.0% vs 66.3%± 19.1%, mean difference:11.01%, 95% CI:7.3%-14.7%, P< 0.001), and subjective sleep quality as assessed by the Richards-Campbell Sleep Questionnaire (68 ± 13 vs 59 ± 15, mean difference:9.31, 95% CI:6.35– 12.27, P< 0.001). There was no between-group difference in dNCR at day 7 or day 30 (both P > 0.05). Dexmedetomidine was associated with a higher incidence of bradycardia during the preoperative night (37.9% vs 16.7%; RR:2.28, 95% CI:1.55– 3.34, P < 0.001), while the incidence of other adverse events was similar between groups (all P > 0.05).
Conclusion: Preoperative intranasal dexmedetomidine reduced the incidence of POD and enhanced preoperative sleep quality in elderly patients with sleep disorders undergoing major noncardiac surgery. Given the increased risk of bradycardia, these benefits should be weighed against the need for perioperative monitoring.
Keywords: geriatric anesthesia, sleep quality, neurocognitive disorders, delirium prevention, alpha-2 adrenergic agonists