• Livia Stocco Sanches Valentin, Valeria Fontenelle Angelim Pereira, Ricardo S Pietrobon, Andre P Schmidt, Jean P Oses, Luis V Portela, Diogo O Souza, João Ricardo Nickenig Vissoci, Vinicius Fernando da Luz, Leticia Maria de Araujo de Souza Trintoni, Karen C Nielsen, and Maria José Carvalho Carmona.
• Department of Anesthesia, LIM 8 -Laboratory of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
• Plos One. 2016 Jan 1; 11 (5): e0152308.

UnlabelledPostoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery.MethodsOne hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35-45 or 46-55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100β was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant.ResultsOn the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35-45, and BIS 46-55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35-45 and BIS 46-55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46-55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100β serum levels.ConclusionDexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46-55. The effect of dexamethasone on S100β might be related with some degree of neuroprotection.Trial Registrationwww.clinicaltrials.gov NCT01332812.

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