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

Rezaei, Mansour; Dehghani, Abbasali

doi:10.22034/mphrj.2026.587074.1103

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

Document Type : Original Article

Authors

Mansour Rezaei

Abbasali Dehghani

Associate Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

https://doi.org/10.22034/mphrj.2026.587074.1103

Abstract

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 2023 at Imam Reza Hospital, Tabriz University of Medical Sciences. Fifty patients (25 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 = 0.002) and lower TNF α levels at the end of surgery (P = 0.003) and 24 hours postoperatively (P < 0.001). The incidence of postoperative delirium was reduced (16.00% vs. 40.00%, P = 0.048), with delayed onset (P = 0.011), shorter duration (P = 0.004), and lower CAM ICU scores (P = 0.002). Peak TNF α levels correlated positively with delirium severity (r = 0.79, P < 0.001).

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.

Graphical Abstract

Keywords

Dexmedetomidine

Postoperative Delirium

Tumor Necrosis Factor Alpha

Esophagectomy

Subjects

Breast Research

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