Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Abstract Introduction: Postoperative delirium is a frequent complication associated with prolonged recovery, increased morbidity, and higher healthcare costs. Dexmedetomidine may reduce delirium through its sedative, analgesic-sparing, and sympatholytic effects, although evidence remains inconsistent. This randomized controlled trial aimed to evaluate the effect of intraoperative dexmedetomidine administration on postoperative delirium scores during the first 72 hours.

Material and methods: In this double-blind, randomized controlled trial conducted at Imam Reza Hospital, 50 surgical patients were allocated (1:1) to receive either intraoperative dexmedetomidine (0.5 µg/kg bolus, then 0.2–0.5 µg/kg/h infusion) or 0.9% normal saline. Postoperative delirium was evaluated during the first 72 hours using the Confusion Assessment Method (CAM/CAM-S).

Results: Across the first 72 postoperative hours, the dexmedetomidine group showed consistently lower delirium severity and incidence than controls, with the greatest separation at 24–48 hours; delirium scores peaked early and then declined in both groups, but remained lower with dexmedetomidine at every assessment (all time points: P<0.05). In parallel, the dexmedetomidine group had lower intraoperative heart rate and slightly lower mean arterial pressure, along with significantly lower postoperative VAS pain scores from 1 to 24 hours (all comparisons: P<0.05).

Conclusion: Intraoperative dexmedetomidine appears to reduce early postoperative delirium burden while improving analgesia and maintaining acceptable hemodynamic stability. These findings support its role as a useful perioperative adjunct, likely through attenuation of surgical stress, sympathetic activation, and pain-related neurocognitive disruption.

Abstract Introduction: Esophagectomy is a high-risk operation often complicated by postoperative morbidity, especially anastomotic leakage, pulmonary complications, and prolonged hospitalization. Because sarcopenia reflects reduced physiologic reserve and impaired recovery potential, it may help identify patients at greater risk for poor short-term outcomes. Therefore, this study aimed to evaluate the impact of preoperative sarcopenia on short-term surgical complications, anastomotic leakage, and hospital stay.

Material and methods: This descriptive cross-sectional study included 75 adults undergoing elective esophagectomy at Imam Reza Hospital, Tabriz. Participants were recruited by convenience sampling. Preoperative sarcopenia was assessed using L3-level computed tomography to calculate the skeletal muscle index, and its associations with postoperative complications, anastomotic leakage, intensive care and hospital stay were evaluated using clinical and surgical data.

Results: Preoperative sarcopenia was associated with higher rates of overall complications, pulmonary complications, anastomotic leakage, surgical-site infection, atrial fibrillation, and 30-day readmission/mortality, as well as longer hospital and ICU stays. In adjusted analyses, sarcopenia remained an independent predictor of adverse outcomes, including overall complications (AOR 2.10, 95% CI 1.20–3.68; P=0.009), anastomotic leakage (AOR 2.35, 95% CI 1.01–5.47; P=0.047), pulmonary complications (AOR 2.80, 95% CI 1.40–5.60; P=0.003), major morbidity (AOR 2.65, 95% CI 1.30–5.40; P=0.007), and prolonged hospital stay (AOR 1.95, 95% CI 1.10–3.45; P=0.021).

Conclusion: Preoperative sarcopenia appears to be a clinically meaningful marker of poor short-term recovery after esophagectomy. Its association with increased postoperative complications and prolonged hospitalization supports routine preoperative muscle assessment to improve risk stratification and guide targeted perioperative optimization.