Comparison of the Inflammatory Response in Patients Undergoing Surgery for Degenerative Spinal Diseases: Sevoflurane-Based Balanced Anesthesia Versus Target-Controlled Propofol Infusion (TCI)

November 8, 2026 updated by: Mateo Peric, University Clinical Hospital Mostar

Comparison of the Inflammatory Response of the Organism After Surgical Treatment of Degenerative Spina Diseases Under Balanced Anesthesia and Target Controlled Infusion Anesthesia

A prospective cohort study with patients undergoing surgery at the Neurosurgery Clinic of the University Clinical Hospital Mostar.

Inclusion/Exclusion Criteria: Inclusion criteria will be: a) patients over 18 years of age undergoing elective surgery for degenerative spine diseases b) ASA status 1-3 Exclusion criteria will be: a) emergency surgeries b) spinal trauma c) allergy to any of the drugs routinely administered during surgery (cefazolin, pantoprazole, metoclopramide, sevoflurane, propofol, fentanyl) d) patients under 18 years of age e) ASA status 4 Variables and Data Sources: General patient data will be collected (gender, age, height, weight), comorbidities, and baseline values for hemoglobin, hematocrit, leukocytes, C-reactive protein (CRP), interleukin 6 (IL-6), ferritin, blood glucose (BG), creatine kinase, myoglobin, and cholesterol. These values will be monitored on the first and second postoperative days, and the dynamics of the results will be recorded. Intraoperatively, the need for vasopressors and transfusions will be documented, and the occurrence of postoperative infections, as well as postoperative nausea and vomiting, will be monitored.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Patients undergoing surgical treatment for degenerative spinal disease will be randomly assigned to two groups.

The first group will receive balanced anesthesia. Anesthesia will be induced using propofol, fentanyl, and a neuromuscular blocking agent, most commonly atracurium, while hypnosis will be maintained using an inhaled mixture of sevoflurane, oxygen, and air.

The second group will receive total intravenous anesthesia (TIVA). Anesthesia will be induced in the same manner as in the first group, while hypnosis during surgery will be maintained by a continuous infusion of propofol, adjusted according to the target plasma concentration of propofol (target-controlled infusion anesthesia - TCI anesthesia), with an oxygen-air mixture.

All patients will have their comorbidities documented, with particular emphasis on obesity, arterial hypertension, hypercholesterolemia, and diabetes mellitus. Their American Society of Anesthesiologists (ASA) physical status classification will also be recorded.

Patients' sex, body weight, and height will be recorded, and their body mass index (BMI) will be calculated.

Before transfer to the operating room, all participants will receive premedication with midazolam at a dose of 0.02-0.04 mg/kg. Antibiotic prophylaxis with a first-generation cephalosporin will be administered and repeated every three hours.

Preoperative baseline levels of hemoglobin, hematocrit, leukocytes, C-reactive protein (CRP), interleukin-6 (IL-6), ferritin, blood glucose, creatine kinase (CK), myoglobin, and cholesterol will be measured. The same laboratory parameters will be assessed on the first and second postoperative days, and changes in their values over time will be recorded. Intraoperative blood glucose levels will also be monitored.

The need for blood product transfusion will be documented.

The depth of anesthesia will be monitored intraoperatively using entropy monitoring, and anesthetic doses will be adjusted to maintain entropy values between 40 and 60.

An arterial catheter will be inserted in all patients for invasive arterial blood pressure monitoring. Blood pressure will be maintained within 30% of the initial recorded value. Hypotension will be treated with ephedrine and/or norepinephrine. The administration of these medications will be documented and compared between the two groups.

Normal saline and other balanced crystalloid solutions will be used for intraoperative fluid replacement.

Before the end of surgery, all patients will receive analgesics for postoperative pain management. Antiemetic medications will also be administered, and the incidence of postoperative nausea and vomiting will be recorded.

Pain levels will be assessed before and after surgery. The duration of anesthesia will be documented. Pain intensity will be measured using the Visual Analog Scale (VAS).

The incidence of postoperative surgical site infections will also be monitored.

**Exclusion criteria** will include patients under 18 years of age, emergency surgical procedures, surgery for malignant diseases, and patients with contraindications to cephalosporins or any of the anesthetic agents used in the study.

The planned duration of the study is one to two years.

All surgical procedures will be performed in the neurosurgical operating room of the University Clinical Hospital Mostar. Intraoperative computed tomography (CT) with navigation will be used to ensure more precise placement of spinal implants.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
100

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

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Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • patients over 18 years of age undergoing elective surgery for degenerative spine diseases
  • ASA status 1-3

Exclusion Criteria:

  • emergency surgeries
  • spinal trauma
  • allergy to any of the drugs routinely administered during surgery (cefazolin, pantoprazole, metoclopramide, sevoflurane, propofol, fentanyl)
  • patients under 18 years of age
  • ASA status 4
  • patients with imunosupressive therapy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Sevoflurane-Based Balanced Anesthesia

Patients undergoing surgery for degenerative spinal diseases will receive balanced general anesthesia maintained with sevoflurane. The perioperative inflammatory response will be assessed using inflammatory biomarkers.
Drug: Sevoflurane

General anesthesia maintained with inhaled sevoflurane as part of a balanced anesthesia technique during surgery for degenerative spinal diseases.
Experimental: Propofol-Based Total Intravenous Anesthesia (TCI)

Patients undergoing surgery for degenerative spinal diseases will receive total intravenous anesthesia maintained with propofol administered using target-controlled infusion (TCI). The perioperative inflammatory response will be assessed using inflammatory biomarkers.
Drug: propofol

General anesthesia maintained with intravenous propofol administered using target-controlled infusion (TCI) during surgery for degenerative spinal diseases.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in Serum Interleukin-6 (IL-6) Concentration
Time Frame: Before anesthesia induction (baseline), 4 hours and 24 hours after completion of surgery.

Change in serum IL-6 concentration from baseline will be compared between patients receiving sevoflurane-based balanced anesthesia and propofol-based total intravenous anesthesia (TCI). IL-6 concentrations will be measured using an ELISA assay.
Before anesthesia induction (baseline), 4 hours and 24 hours after completion of surgery.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University Clinical Hospital Mostar

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
November 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
June 1, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 1, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 8, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 8, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 13, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 13, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 8, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
November 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • eticko 224/25

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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