Cognitive Protection - Dexmedetomidine and Cognitive Reserve

June 27, 2019 updated by: Icahn School of Medicine at Mount Sinai
This is a pilot study to evaluate the effect of dexmedetomidine in the prevention of delirium in non-cardiac surgical patients. The preliminary data regarding the effect of dexmedetomidine on delirium comes from a study underway at Stanford. We propose to randomize fifty patients into two different protocols, one using dexmedetomidine until PACU discharge (hip replacement) and the other using dexmedetomidine for 24 hours in a monitored setting.

Study Overview

Detailed Description

Elderly patients who undergo anesthesia and non-cardiac surgery are subject to deterioration of brain function including the development of postoperative delirium (PD) and postoperative cognitive dysfunction (POCD). These disorders cause disability, distress for both patients and their families, are associated with other medical complications and account for significant additional health care costs. We currently use relatively primitive approaches to preventing and treating PD and POCD. The proposed is a pilot study for an NIH grant which was recently submitted. This is a randomized controlled trial of perioperative dexmedetomidine to prevent PD and, potentially, POCD. Fifty patients will be enrolled at Mount Sinai with two different surgeries, either hip replacement or vascular bypass. The patients undergoing hip replacement will receive dexmedetomidine until discharge from the PACU. Vascular surgery patients who are transferred from the PACU to a monitored step-sown unit will continue dexmedetomidine for 24 hours.Participants will be screened for Mild Cognitive Impairment (MCI), and undergo preoperative cognitive testing. Unlike the parent trial, we will test for but will not select for patients with MCI. Participants will be randomized to either dexmedetomidine or placebo which will be started prior to surgery and continued for 24 hours postoperatively. Follow up studies will include surveillance for delirium while in the hospital and cognitive testing at 3 months following surgery.

Dexmedetomidine is a drug used for sedation in critically ill patients that provides some pain relief and controls the bodies response to stress. The sedation produced by dexmedetomidine appears more similar to natural sleep than any other drug used for anesthesia and postoperative sedation. Data suggesting that dexmedetomidine can prevent delirium following cardiac surgery and the developing understanding of the causes of PD and POCD suggest that dexmedetomidine will be particularly effective.

Study Type

Interventional

Enrollment (Actual)

27

Phase

  • 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 Locations

    • New York
      • New York, New York, United States, 10029
        • Icahn School of Medicine at Mount Sinai

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

Ages Eligible for Study

65 years and older (Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • age 65 years and older
  • elective major hip replacement or peripheral vascular (major surgery is defined by a planned 2 day hospitalization)
  • ASA physical status I-III
  • capable and willing to consent

Exclusion Criteria:

  • Cardiac surgery
  • Intracranial Surgery
  • Emergency Surgery
  • Patients with severe visual or auditory disorder/handicaps
  • Illiteracy
  • Patients with clinically significant Parkinson's Disease
  • Patients not expected to be able to complete the 3 month postoperative test
  • Sick sinus syndrome without pacemaker
  • Hypersensitivity to drug or class
  • Current 2nd or 3rd degree AV block
  • History of clinically significant bradycardia
  • Contraindication to the use of an 2A-agonist
  • Presence of a major psychiatric condition such as bipolar disorder, major depression, schizophrenia, or dementia
  • ASA physical status IV or V

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: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Dexmedetomidine
Participants will be randomized to either dexmedetomidine or placebo which will be started prior to surgery and continued for 24 hours postoperatively. Patients will receive dexmedetomidine until discharge from the PACU.
Dexmedetomidine started prior to surgery and continued for 24 hours postoperatively. Patients will receive dexmedetomidine until discharge from the PACU.
Other Names:
  • Precedex
  • Dexmedetomidine
Placebo Comparator: Placebo
Participants will be randomized to either dexmedetomidine or placebo which will be started prior to surgery and continued for 24 hours postoperatively or until discharge from the PACU.
Matching placebo given prior to surgery and continued for 24 hours postoperatively

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Functional Recovery
Time Frame: 3 months post surgery
3 months post surgery
Functional Recovery
Time Frame: 6 months post surgery
6 months post surgery

Secondary Outcome Measures

Outcome Measure
Time Frame
Cognitive Testing
Time Frame: prior to surgery
prior to surgery
Cognitive Testing
Time Frame: 3 months post surgery
3 months post surgery
Cognitive Testing
Time Frame: 6 months post surgery
6 months post surgery
Delirium Assessments
Time Frame: prior to surgery
prior to surgery
Delirium Assessments
Time Frame: duration of PACU stay, up to 4 days post-op
duration of PACU stay, up to 4 days post-op
Delirium Assessments
Time Frame: 3 months post surgery
3 months post surgery
Delirium Assessments
Time Frame: 6 months post surgery
6 months post surgery

Collaborators and Investigators

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

Investigators

  • Principal Investigator: Jeff Silverstein, MD, Icahn School of Medicine at Mount Sinai

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

September 1, 2006

Primary Completion (Actual)

April 1, 2009

Study Completion (Actual)

April 1, 2009

Study Registration Dates

First Submitted

April 2, 2007

First Submitted That Met QC Criteria

April 2, 2007

First Posted (Estimate)

April 3, 2007

Study Record Updates

Last Update Posted (Actual)

July 17, 2019

Last Update Submitted That Met QC Criteria

June 27, 2019

Last Verified

June 1, 2019

More Information

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.

Clinical Trials on Postoperative Delirium

Clinical Trials on Precedex (Dexmedetomidine)

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