Randomized controlled trial of preoperative application of high-dose glucocorticoids for prevention of postoperative delirium in patients with partial hepatectomy

Objective  To evaluate the effect of different doses of glucocorticoids in prevention of postoperative delirium in patients with partial hepatectomy.

Methods  A total of 135 patients with intended laparoscopic partial hepatectomy in our hospital from January to December 2021 were selected as the research objects, and they were randomly divided into high-dose glucocorticoid group, low-dose glucocorticoid group and placebo group, with 45 cases in each group. Intervention drugs were injected at 30 minutes before anesthesia induction; the high-dose glucocorticoid group received intravenous injection of 5.0 mg/kg methylprednisolone, with a maximum dose of 500 mg; the low-dose glucocorticoid group received intravenous injection of 2.5 mg/kg methylprednisolone, with a maximum dose of 250 mg; the placebo group received intravenous injection of 100 mL 0.9% sodium chloride injection. At 1, 2 and 3 d after operation, postoperative delirium was evaluated by the Confusion Assessment Method (CAM), and postoperative pain was evaluated by the Visual Analogue Scale (VAS). Indicators such as intraoperative bleeding volume, anesthetic dosage and surgical time were recorded; the delayed recovery, restlessness in the awakening stage, residence time in the post-anesthesia care unit (PACU), hospital stay, and postoperative nausea and vomiting (PONV) were recorded.

Results  Incidence of postoperative delirium in the high-dose glucocorticoid group was significantly lower than that in the placebo group (P < 0.05). There were no significant differences in intraoperative low blood pressure, bleeding volume, cases with blood transfusion, dosages of remifentanil and propofol as well as operation time among the three groups (P > 0.05). There were no significant differences in the residence time in PACU, delayed recovery, restlessness in the awakening stage, incidence of PONV and hospital stay among the three groups (P > 0.05). The result of Logistic regression analysis showed that preoperative intravenous injection of high-dose glucocorticoids (OR=0.032; 95%CI, 0.001 to 0.968; P=0.048) can reduce the risk of postoperative delirium, while older age (OR=1.379; 95%CI, 1.086 to 1.751; P=0.008) and delayed recovery (OR=18.930; 95%CI, 2.541 to 140.950; P=0.004) can increase the risk of postoperative delirium.

Conclusion  Preoperative intravenous injection of high-dose glucocorticoids can effectively prevent postoperative delirium in patients with partial hepatectomy.