The Effect of Dexmedetomidine on Preventing Postoperative Delirium by Modulating Tumor Necrosis Factor-Alpha (TNF-α) Levels in Patients Undergoing Esophagectomy

Introduction: Esophagectomy-induced systemic inflammation, specifically elevated TNF-α, significantly contributes to postoperative delirium. Dexmedetomidine may mitigate this cognitive decline through its potent anti-inflammatory and neuroprotective effects. This study investigates whether dexmedetomidine prevents postoperative delirium by modulating TNF-α levels in patients undergoing esophagectomy.Material and methods: This prospective randomized study was conducted in ۲۰۲۳ at Imam Reza Hospital, Tabriz University of Medical Sciences. Fifty patients (۲۵ per group), determined using the two independent sample formula, were enrolled. The primary variables included perioperative TNF α levels and the incidence of postoperative delirium, along with demographic characteristics, intraoperative hemodynamics, anesthetic requirements, and ICU stay duration.Results: Dexmedetomidine significantly attenuated postoperative TNF α elevation compared with control, with a significant time by group interaction (P = ۰.۰۰۲) and lower TNF α levels at the end of surgery (P = ۰.۰۰۳) and ۲۴ hours postoperatively (P < ۰.۰۰۱). The incidence of postoperative delirium was reduced (۱۶.۰۰% vs. ۴۰.۰۰%, P = ۰.۰۴۸), with delayed onset (P = ۰.۰۱۱), shorter duration (P = ۰.۰۰۴), and lower CAM ICU scores (P = ۰.۰۰۲). Peak TNF α levels correlated positively with delirium severity (r = ۰.۷۹, P < ۰.۰۰۱).Conclusion: Perioperative dexmedetomidine administration reduced postoperative delirium and mitigated its severity following esophagectomy, likely through suppression of TNF α–mediated inflammatory responses. The observed association between inflammatory burden and delirium severity supports a mechanistic link between systemic inflammation and postoperative neurocognitive dysfunction.

کلیدواژه ها:

dexmedetomidine ، Postoperative delirium ، Tumor Necrosis Factor alpha ، Esophagectomy