- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00788008
Cognitive Effects of Inhalational Versus Intravenous General Anesthesia in the Elderly
Does Inhalational Anesthesia Accelerate Postoperative Cognitive Decline?
Study Overview
Status
Intervention / Treatment
Detailed Description
A prospective randomized pre-test post-test design will be used. After obtaining informed consent, patients will be randomized to either: 1) Inhalational anesthesia with isoflurane or 2) Total intravenous anesthesia(TIVA) with propofol. Randomization will be stratified by surgical type so that this variable is equally distributed between the treatment groups. All patients will be maintained at a standard depth of anesthesia (40-60) using a Bispectral Index (BIS®) monitor. Normocarbia will be maintained in the operating room using capnography monitoring. Normothermia will be maintained throughout the procedure.
The anesthesia team providing care for these patients will be able to choose the premedication and muscle relaxant for the anesthetic technique. Patient controlled anesthesia or regional anesthetic techniques may be used for post-operative analgesia at the discretion of the anesthesia team providing care for these patients. Anesthesia will be induced with intravenous propofol and fentanyl in all patients, unless contraindicated. Patients will be mechanically ventilated with air/oxygen. Temperature will be maintained > 35º C and ventilation will be adjusted to maintain end-tidal carbon dioxide (CO2) at 35 ± 5 mmHg. Mean arterial pressure will be maintained ≥ 75% of baseline or ≥ 60 mmHg, whichever is greater, in both groups. After induction of anesthesia, the maintenance anesthesia will consist of either:
- Inhalational anesthesia group - isoflurane will be used for maintenance of anesthesia. Intravenous fentanyl and/or remifentanil will be used for supplementary analgesia. These agents will be administered to maintain a normal depth of anesthesia using the BIS® monitor and traditional signs of anesthetic depth.
- TIVA group - propofol and opioid infusions (fentanyl or remifentanil) will be used for the maintenance of anesthesia. The infusions will be adjusted to maintain a normal depth of anesthesia using the BIS® monitor along with traditional signs of anesthetic depth.
All subjects will undergo pre-operative neurocognitive testing within two weeks of their surgery, and at 3 months post-surgery. The persistence versus resolution of cognitive deficits over time will be determined with a 1 year post-surgical follow-up assessment. Pre- to post-test change scores will be compared across groups on primary and secondary outcome variables (see below) while controlling for relevant demographic variables (age, education, sex).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
North Carolina
-
Durham, North Carolina, United States, 27710
- Duke University Medical Center
-
Durham, North Carolina, United States, 27710
- VAMC
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- patients (aged 65 years or older) scheduled for elective spine or major joint replacement (total hip or total knee arthroplasty) at Duke University Medical Center or the Durham VA Medical Center
Exclusion Criteria:
- not fluent in English and able to comprehend the English language
- have severe visual or auditory handicaps
- Carry a diagnosis of dementia or score < 18 on the Mini-Mental State Examination (MMSE) as calculated from the Modified Mini-Mental State (3MS) (see D4 below)
- have allergies to eggs, propofol, isoflurane, fentanyl, remifentanil, or pregabalin
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 1
Inhalational anesthesia with isoflurane
|
variable depending upon patient
Other Names:
|
Active Comparator: 2
total intravenous anesthesia with propofol
|
variable depending upon patient
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Neurocognitive Performance (Z-score)
Time Frame: 3 months post operatively
|
Mean change on composite scores (z-score) for memory and executive function measures. Memory measures: Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised. Executive function measures: the Trail Making Test (Army, 1944), Digit-symbol substitution and Symbol Search subtests of the Processing Speed Index of the Wechsler Adult Intelligence Scale-III (WAIS-III; Wechsler, 1997) and the Controlled Oral Word Association subtest of the Multilingual Aphasia Examination. The outcomes were constructed as summed z-score composites. They are scaled as standard deviations. Thus, a score of 0 was central on each composite, and 95% of the scores would fall within -2.0 and +2.0. While there is no minimum or maximum value is rare for any score (<1%) to fall outside the -3.0 to +3.0 range. Higher scores (and thus positive change value) indicate an improvement of function. |
3 months post operatively
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Terri G Monk, MD, Duke University
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Joint Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Arthritis
- Spinal Diseases
- Bone Diseases
- Osteoarthritis
- Osteoarthritis, Knee
- Osteoarthritis, Hip
- Spondylosis
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Hypnotics and Sedatives
- Anesthetics, Inhalation
- Propofol
- Isoflurane
Other Study ID Numbers
- Pro00010070
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 Knee Osteoarthritis
-
LifeBridge HealthMicroPort Orthopedics Inc.; Rubin Institute for Advanced OrthopedicsRecruitingKnee Osteoarthritis | Osteoarthritis, Knee | Knee Pain Chronic | Arthropathy of Knee Joint | Knee Disease | Osteoarthritis Knees Both | Osteoarthritis Knee Left | Osteoarthritis Knee RightUnited States
-
University Hospital, Clermont-FerrandSanofiCompletedKnee Osteoarthritis (Knee OA)France
-
Jiangsu XinChen-Techfields Pharma Co., LTD.Completed
-
Novartis PharmaceuticalsRecruitingSymptomatic Knee OsteoarthritisUnited States, Spain, Hungary, Argentina, Germany, Slovakia, Czechia, Belgium, Romania
-
University of BathUniversity of Oxford; 3D Metal Printing Ltd; Versus ArthritisRecruitingMedial Knee OsteoarthritisUnited Kingdom
-
Max Biocare Pty. Ltd.Completed
-
University of IowaThe American Geriatrics SocietyCompletedKnee Osteoarthritis | Symptomatic Knee OsteoarthritisUnited States
-
Laval UniversityFonds de la Recherche en Santé du Québec; Natural Sciences and Engineering... and other collaboratorsCompleted
-
Chonbuk National University HospitalCompletedMild Knee OsteoarthritisKorea, Republic of
Clinical Trials on inhalation anesthesia with isoflurane vs. TIVA with propofol
-
Duke UniversityCompletedPostoperative Delirium | Alzheimers Disease | Post Operative Cognitive DysfunctionUnited States
-
Seoul National University HospitalCompletedEnhanced Recovery After SurgeryKorea, Republic of
-
Carilion ClinicEnrolling by invitationRotator Cuff Injuries | Anesthesia | Orthopedic Disorder | Rotator Cuff Tears | Sports InjuryUnited States
-
Aga Khan UniversityCompleted
-
Mansoura UniversityCompletedTotal Laryngectomy | Cancer LarynxEgypt
-
Liang ZhangUnknownCoronary Artery Bypass Graft Triple VesselChina
-
Medical University of GdanskCompleted
-
Affiliated Cancer Hospital & Institute of Guangzhou...Unknown
-
University Hospital, RouenRecruiting
-
Uludag UniversityCompletedPostoperative Complications | Sleep Disturbance | Regional Anesthesia MorbidityTurkey