Effects of dexamethasone on cognitive decline after cardiac surgery a randomized clinical trial

Thomas H. Ottens*, Anne Mette C. Sauër, Linda M. Peelen, Welmer J. De Groot, Marc P. Buijsrogge, Jaap J. Bredée, Wolfgang F. Buhre, Jan M. Dieleman, Diederik Van Dijk, Lex A. Van Herwerden, Cor J. Kalkman, Jan Van Klarenbosch, Karel G. Moons, Hendrik M. Nathoe, Sandra C. Numan, Kit C. Roes, Arjen J. Slooter, Arno P. Nierich, Jacob J. Ennem, Peter M. RosseelNardo J. Van Der Meer, Joost M. Van Der Maaten, Vlado Cernak, Jan Hofland, Robert J. Van Thiel, Jan C. Diephuis, Ronald M. Schepp, Jo Haenen, Fellery De Lange, Christa Boer, Jan R. De Jong, Jan G. Tijssen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Cardiac surgery can be complicated by postoperative cognitive decline (POCD), which is characterized by impaired memory function and intellectual ability. The systemic inflammatory response that is induced by major surgery and cardiopulmonary bypass may play an important role in the etiology of POCD. Prophylactic corticosteroids to attenuate the inflammatory response may therefore reduce the risk of POCD. The authors investigated the effect of intraoperative high-dose dexamethasone on the incidence of POCD at 1 month and 12 months after cardiac surgery. Methods: This multicenter, randomized, double-blind, placebo-controlled trial is a preplanned substudy of the DExamethasone for Cardiac Surgery trial. A total of 291 adult patients undergoing cardiac surgery with cardiopulmonary bypass were recruited in three hospitals and randomized to receive dexamethasone 1 mg/kg (n = 145) or placebo (n = 146). The main outcome measures were incidence of POCD at 1- And 12-month follow-up, defined as a decline in neuropsychological test performance beyond natural variability, as measured in a control group. Results: At 1-month follow-up, 19 of 140 patients in the dexamethasone group (13.6%) and 10 of 138 patients in the placebo group (7.2%) fulfilled the diagnostic criteria for POCD (relative risk, 1.87; 95% CI, 0.90 to 3.88; P = 0.09). At 12-month follow-up, 8 of 115 patients in the dexamethasone group (7.0%) and 4 of 114 patients (3.5%) in the placebo group had POCD (relative risk, 1.98; 95% CI, 0.61 to 6.40; P = 0.24). Conclusion: Intraoperative high-dose dexamethasone did not reduce the risk of POCD after cardiac surgery.

Original languageEnglish
Pages (from-to)492-500
Number of pages9
JournalAnesthesiology
Volume121
Issue number3
DOIs
Publication statusPublished - 1 Jan 2014

Cite this

Ottens, T. H., Sauër, A. M. C., Peelen, L. M., De Groot, W. J., Buijsrogge, M. P., Bredée, J. J., ... Tijssen, J. G. (2014). Effects of dexamethasone on cognitive decline after cardiac surgery a randomized clinical trial. Anesthesiology, 121(3), 492-500. https://doi.org/10.1097/ALN.0000000000000336