- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01983384
Anesthetic Depth and Postoperative Delirium Trial - 2 (ADAPT2)
A Randomised Controlled Trial to Reduce Postoperative Delirium Through Reduction in Intraoperative EEG Suppression in Older Surgical Patients Undergoing Major Noncardiac Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Recently, it has been proposed that use of a processed electroencephalogram (EEG) monitor during surgery may be associated with a lower rate of postoperative delirium. In fact, some suggest that older patients undergoing surgery should routinely be monitored with an anesthetic depth monitor to allow the titration of anesthetics or sedation medications to lighter levels to promote better postoperative cognitive outcomes. Recent studies, including preliminary results from our group, have demonstrated electroencephalogram (EEG) suppression to be an independent risk factor for postoperative delirium.
Prior studies that have focused on risk prediction have shown age and prior cognitive impairment to be the most consistent risk factors for postoperative delirium. However, as of yet, no clinical trial has identified a relationship whether use of processed EEG monitor resulted in a reduction of incident postoperative delirium through a reduction in EEG suppression, with proper consideration of patients' baseline cognitive status as a potential moderator. Additionally, use of anesthetic depth monitor to keep patients' anesthetic depth above a specified value has never been validated or proven to be feasible or safe.
Accordingly, the investigators plan an exploratory study to: 1) determine whether the use of processed EEG to keep anesthetic depth above a specified level, results in a reduction in EEG suppression when compared to standard anesthetic care, 2) to determine whether preoperative level of cognitive function moderates the effect of group assignment on EEG suppression, and 3) to determine the feasibility and safety of using processed EEG-guided to keep patients' anesthetic depth above a specified value. A secondary aim was to determine the effect size for the intervention to reduce postoperative delirium for subjects with and without preoperative cognitive impairment for a future trial.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
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California
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San Francisco, California, United States, 94143-0648
- University of California, San Francisco Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 65 years and older of age undergoing non-cardiac surgery, requiring hospital stay of 2 or more days.
Exclusion Criteria:
- patients who are not fluent in English or cannot provide informed consent
- patients who may not tolerate either light or deep anesthesia (history of heart failure, coronary artery disease, substance abuse)
- history of intraoperative recall or awareness during anesthesia
- pathologies of the brain which may affect EEG monitoring
- patients who are anticipated to have consecutive surgery within 3 days of first procedure
- patients who have had surgery with general anesthesia in the past 30 days
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Anesthetic Depth: standard care
A cohort of older patients undergoing major non-cardiac surgery will be randomized to receive routine anesthetic management not guided by the processed electroencephalogram
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Investigators will undertake a randomized control trial in a cohort of older patients undergoing major non-cardiac surgery to receive either a control vs. an intervention of anesthesia as determined by a processed electroencephalogram
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Experimental: Anesthetic Depth: interventional
A cohort of older patients undergoing major non-cardiac surgery will be randomized to receive anesthetic management guided by the processed electroencephalogram (processed EEG-guided anesthetic depth)
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Investigators will undertake a randomized control trial in a cohort of older patients undergoing major non-cardiac surgery to receive either a control vs. an intervention of anesthesia as determined by a processed electroencephalogram
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Intraoperative EEG Suppression
Time Frame: Patients will be monitored by processed EEG intraoperatively, for the duration of surgery
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Intraoperative EEG suppression will be measured by processed EEG monitor
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Patients will be monitored by processed EEG intraoperatively, for the duration of surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Preoperative level of cognitive function
Time Frame: Up to one week before surgery
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Level of cognitive function will be measured by Telephone Interview for Cognitive Status
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Up to one week before surgery
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Patient intraoperative awareness and recall
Time Frame: Intraoperative recall and awareness will be measured within 72 hours after end of surgery
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Intraoperative recall and awareness measured using modified Brice questionnaire (2 question survey - each answered with a yes or no, with additional checkboxes for applicable descriptions of events recalled [e.g.
"Hearing voices," "Feeling pain," etc]) Patients answering yes to either question are classified as accidental awareness after general anesthesia (AAGA), which is regarded as an intraoperative adverse event.
|
Intraoperative recall and awareness will be measured within 72 hours after end of surgery
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Patient movement
Time Frame: During surgery
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Patient movement will be recorded from the anesthesia record
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During surgery
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Intraoperative systolic and diastolic blood pressure
Time Frame: During surgery
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Intraoperative systolic and diastolic blood pressure will be continuously downloaded onto a computer for subsequent analysis.
Increases or decreases above the preoperative baseline measurements will be measured and recorded from the medical record
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During surgery
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Intraoperative heart rate
Time Frame: During surgery
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Intraoperative heart rate will be continuously downloaded onto a computer for subsequent analysis.
Increases or decreases above the preoperative baseline measurements will be measured and recorded from the medical record
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During surgery
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Anesthesiologists' adherence to assigned processed EEG index in the interventional group
Time Frame: Anesthesiologists complete self-report within 72 hours after end of surgery. This outcome measure is collected once for each patient through study completion, an average of 2 years.
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Anesthesiologists' assigned to patients randomized to the interventional group were given a short self-report survey at the end of each surgery (e.g.
"Did the PSI go below the PSI threshold of 35 at any point during surgery?")
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Anesthesiologists complete self-report within 72 hours after end of surgery. This outcome measure is collected once for each patient through study completion, an average of 2 years.
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Postoperative delirium
Time Frame: Daily for three postoperative days.
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Research staff, blinded to group assignment, will assess for delirium using the Confusion Assessment Method, a physician-validated screening tool for hospital delirium
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Daily for three postoperative days.
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Jacqueline Leung, MD, MPH, University of California, San Francisco
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ANESDEPTH
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated device product
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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