Pandey CK, Kumar A. Perioperative neurocognitive dysfunction and role of dexmedetomidine in radical colon cancer surgery in elderly patients. World J Gastrointest Surg 2025; 17(3): 100126 [DOI: 10.4240/wjgs.v17.i3.100126]
Corresponding Author of This Article
Chandra K Pandey, MD, Professor, Department of Anaesthesiology, Medanta Hospital Lucknow, Sultanpur Road, Lucknow 226030, Uttar Pradesh, India. ceekeypandey@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2025; 17(3): 100126 Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.100126
Perioperative neurocognitive dysfunction and role of dexmedetomidine in radical colon cancer surgery in elderly patients
Chandra K Pandey, Abhishek Kumar
Chandra K Pandey, Department of Anaesthesiology, Medanta Hospital Lucknow, Lucknow 226030, Uttar Pradesh, India
Abhishek Kumar, Department of Anaesthesia, King George Medical University, Lucknow 226003, Uttar Pradesh, India
Co-first authors: Chandra K Pandey and Abhishek Kumar.
Author contributions: Pandey CK and Kumar A contributed to writing and editing the manuscript, illustrations, and review of the literature, contributed equally to this article, and are co-first authors of this manuscript; Pandey CK designed the overall concept and outline of the manuscript; Kumar A contributed to the discussion and design of the manuscript; All authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chandra K Pandey, MD, Professor, Department of Anaesthesiology, Medanta Hospital Lucknow, Sultanpur Road, Lucknow 226030, Uttar Pradesh, India. ceekeypandey@gmail.com
Received: August 7, 2024 Revised: December 21, 2024 Accepted: January 2, 2025 Published online: March 27, 2025 Processing time: 200 Days and 12.7 Hours
Abstract
This article explored the application of dexmedetomidine (Dex), a highly selective alpha-2 agonist, in managing postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical colon cancer surgery. Aging is associated with a progressive decline in physiological functions and an increased risk of adverse surgical outcomes, including POCD, which encompasses many neurocognitive disorders that manifest during the perioperative period. The aging population is at a higher risk for POCD, which can lead to prolonged hospital stays, delayed recovery, and increased healthcare costs. Dex has neuroprotective, opioid-sparing, and sympatholytic properties, which reduces the incidence and severity of POCD. Dex was introduced for sedation in patients receiving mechanical ventilation but has since been adopted in anesthesia due to its multifaceted benefits. Its application extends to sedation, analgesia, maintenance of anesthesia, and controlling delirium. Its neuroprotective and anti-inflammatory effects have been explored in managing POCD. This article discussed the broad range of patient and procedure-related risk factors for POCD. Early identification and intervention are crucial to prevent the progression of POCD, which can have severe physical, psychological, and economic consequences. The article underscored the importance of a multidisciplinary approach in managing POCD, involving the optimization of comorbidities, depth of anesthesia monitoring, hemodynamic stability, and cerebral oxygenation monitoring.
Core Tip: Dexmedetomidine (Dex) is a significant drug that improves surgical outcomes in varied surgeries. The neuroprotective, opioid-sparing, and sympatholytic properties of Dex have shown improved outcomes in the elderly population in various surgeries including radical colon surgeries. The decline in the incidence and severity of postoperative cognitive dysfunction, the decreased surge in proinflammatory markers, improved regional cerebral oxygenation, and better pain control due to Dex lead to improved outcomes, early discharge, and decreased healthcare costs in this vulnerable group of patients.
