Abstract:

Objective

To evaluate the effects of intravenous versus intranasal administration of dexmedetomidine on postoperative cognitive function and agitation in elderly patients undergoing elective laparoscopic tension-free inguinal hernia repair under general anesthesia, and to compare the clinical outcomes of the two administration methods.

Methods

This prospective study included 440 elderly patients scheduled for elective laparoscopic inguinal hernia repair under general anesthesia at Beijing Chaoyang Hospital from February to December 2024.Patients were randomly assigned, using a computer-generated randomization method, to either the intravenous group (IV group, n=220) or the intranasal group (NA group, n=220).The IV group received 0.5 μg/kg dexmedetomidine via intravenous injection before anesthesia, while the NA group received 2 μg/kg intranasal dexmedetomidine.Postoperative cognitive function, agitation, adverse events, and anesthesia recovery time were compared between the two groups.

Results

At 5, 15, and 30 minutes after awakening, Ramsay sedation scores were significantly lower in the IV group compared to the NA group (P<0.01).No significant difference in preoperative cognitive impairment rates was observed between the groups (P>0.05).However, the incidence of cognitive dysfunction on postoperative day 1 and day 3 was significantly lower in the IV group than in the NA group (P<0.001).There was no significant difference in anesthesia recovery time between the IV and NA groups [(15.2±3.6) min vs (16.2±4.1) min, P>0.05].Additionally, no significant differences were observed between the groups in the incidence of adverse events such as hypotension,bradycardia, or nausea and vomiting (P>0.05).

Conclusion

Intravenous administration of dexmedetomidine is superior to intranasal administration in protecting postoperative cognitive function and reducing agitation in elderly patients undergoing hernia repair, with comparable effects on anesthesia recovery time and adverse event profiles.Intravenous dexmedetomidine may thus be a more effective option in postoperative management, particularly for cognitive protection in elderly patients.

Key words: Hernia, inguinal, Herniorrhaphy, Dexmedetomidine, Aged, Anesthesia, Cognition