DEXMEDETOMIDINE AS A NEUROPROTECTIVE STRATEGY IN GENERAL SURGERY: EVIDENCE ON NEUROINFLAMMATION AND POSTOPERATIVE DELIRIUM

Abstract

Postoperative delirium (POD) represents a frequent neuropsychiatric complication in general surgery procedures, associated with increased morbidity, mortality, prolonged hospital stay, and elevated healthcare costs. Neuroinflammation, triggered by surgical stress and microglial activation, plays a central role in the pathogenesis of this cognitive dysfunction. In this scenario, dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist, emerges as a promising intervention due to its sedative, analgesic, and immunomodulatory properties affecting both systemic and central inflammatory responses. The aim of this study was to analyze scientific evidence regarding the use of dexmedetomidine as a neuroprotective strategy in managing neuroinflammation and preventing postoperative delirium in patients undergoing general surgery. This integrative literature review was conducted in Medline/PubMed, LILACS, SciELO, and Web of Science databases, encompassing articles published between 2020 and 2026. A total of 16 studies meeting all eligibility criteria were included. Results demonstrate that perioperative dexmedetomidine infusion significantly reduced circulating levels of pro-inflammatory cytokines, such as IL-6 and TNF-alpha, while markedly decreasing POD incidence compared to other sedative and anesthetic regimens. Favorable modulation of the blood-brain barrier integrity and preservation of sleep architecture were also observed. In conclusion, dexmedetomidine represents an effective and safe neuroprotective strategy in general surgery, mitigating the neuroinflammatory cascade and preventing postoperative delirium, supporting its reasoned integration into multiprofessional perioperative protocols.