- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03785158
MIND After Surgery (MIND)
Melatonin for Preventing Postoperative Delirium in Elderly Patients; a Multi-centre Randomized Placebo Controlled Pilot Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Delirium is defined as an acute and fluctuating disturbance in cognition characterized by alterations in the level of attention and awareness, which develops over a relative short period of time and represents a change from the subject's baseline. Its incidence increases with age and occurs in nearly 50% of elderly inpatients. Postoperative delirium (POD) increases the risk of patient morbidity and mortality and thereby increasing the cost for the health care system. Increased risk of mortality persists even three years after hospitalization, and is an independent risk factor for urinary incontinence, falls, and decubitus ulcers.
A large prospective study of 1341 patients having non-cardiac surgery with a postoperative stay of at least 48 hours, reported an overall incidence of 9% in >50 years and 15% in >70 years. Another recent study involving 566 patients of similar surgical cohort reported an incidence of 24%.
With no current effective treatment, there is a greater focus on prevention of delirium. Approximately 15% of all POD could be preventable. Preventive strategies can be pharmacological and non-pharmacological. Non-pharmacological strategies are multifaceted and involve different interventions. Among attempted pharmacological options, none have really shown much promise and many suffer from associated adverse effects.
Melatonin is a pineal gland hormone that regulates the sleep-wake rhythm. Disruption of the sleep-wake cycle is observed in delirium. Abnormal tryptophan metabolism is hypothesized as a cause for delirium and melatonin supplementation is observed to decrease the breakdown of tryptophan and serotonin through positive feedback. In patients who develop POD, low tryptophan and serum melatonin levels were observed. Other advantages of melatonin, being a natural supplement, include improved sleep, sparing of sedatives, minimal potential for abuse, or hangover effects.
Systematic reviews done with the existing literature specific to melatonin by a literature search of MEDLINE, EMBASE and Cochrane databases for combination of terms "melatonin" and "delirium", restricted to clinical trials and up to October 25, 2017 found one relevant systematic review: this systematic review looked at the use of melatonin for delirium prevention and found four randomized control trials (RCT), out of which three showed positive results and one showed a negative result. Presently, despite its potential to reduce POD and improve sleep, the role of melatonin in the elderly surgical population is uncertain. There is a clear need for a large, well-designed study to establish definitive evidence.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Harsha Shanthanna, MD
- Phone Number: 33853 905-522-1155
- Email: shanthh@mcmaster.ca
Study Contact Backup
- Name: Toni Tidy, BHSc
- Phone Number: 21737 905-525-9140
- Email: tonitidy@mcmaster.ca
Study Locations
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Ontario
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Hamilton, Ontario, Canada, L8N 4A6
- St. Joseph's Healthcare Hamilton
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Hamilton, Ontario, Canada, L8V 1C3
- Hamilton Health Sciences-Juravinski Hospital Location
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age >65 years
- having a major non-cardiac surgery (which involve major vascular, thoracic, orthopedic, gynecological, otolaryngeal, general and gastrointestinal surgeries) with an expected hospital stay of 2 days or more, and
- ability to provide informed consent
Exclusion Criteria:
- active delirium or dementia
- ongoing melatonin treatment
- unable to take oral medications
- planned postoperative ventilation
- previous study participation
- allergy to melatonin
- hepatic impairment defined as alanine aminotransferase greater than 500 IU/L
- previous liver transplant or liver cirrhosis of Child-Pugh classes B and C
- not willing to participate
- language barrier
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Melatonin
3 mg of liquid melatonin by oral route for 8 days.
The 1st dose will be given 1-2 hours prior to the surgery, followed by bed time doses (between 7-9 pm) given on postoperative day (POD) 1 until discharge or for the first 7 days.
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Melatonin is a natural supplement.
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Placebo Comparator: Placebo Group
Similar looking/tasting 3 mg (5 ml) placebo syrup administered preoperatively by oral route and for the next 7 days or until discharge.
The 1st dose will be given 1-2 hours prior to the surgery, followed by bed time doses (between 7-9 pm) given on postoperative day (POD) 1 until discharge or for the first 7 days.
|
Similar looking/tasting placebo syrup
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Recruitment rate
Time Frame: 6 months
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Recruitment rate: assessed as at least 4-5 patients/week, and completion of recruitment (60 patients/site) in each site over 3-4 months.
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6 months
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Medication compliance
Time Frame: 8 days
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Proportion of patients who are able to take at least two doses of study medications, assessed as >85% of study patients.
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8 days
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Follow up to 3 months
Time Frame: 3 months
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Proportion of patients who complete 3 months follow up.
For feasibility we expect >90% patients to complete study follow up.
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3 months
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Proportion of patients recruited from screening
Time Frame: 6 months
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To identify the proportion of screened patients meeting the study inclusion criteria
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6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of Delirium
Time Frame: 8 days
|
This will be captured from observing the patient from the time of their discharge from pre-anesthetic care unit (PACU), until the time of discharge.
Presence or absence will be captured using the Confusion Assessment Method (CAM)-short form.
If patient is mechanically ventilated, the assessment will be performed using Confusion Assessment Method-Intensive Care Unit (CAM-ICU) tool.
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8 days
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Severity of Delirium
Time Frame: 8 days
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When an episode of post-operative delirium is observed, the severity will be assessed using Confusion Assessment Method (CAM) severity form.
We will only record the severity for the first episode of post operative delirium observed.
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8 days
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Sleep quality
Time Frame: 8 days
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Quality of sleep will be assessed daily using Richards-Campbell Sleep Questionnaire (RCSQ).
It is a visual analogue scale 0-100mm; zero indicating the worst possible sleep to 100 indicating the best sleep.
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8 days
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Incidence of ICU care
Time Frame: 8 days
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Need for ICU or critical care during hospitalization: This will be captured along with the reason and duration of such a stay from hospital records/patient charts
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8 days
|
Prolonged hospital stay
Time Frame: 8 days
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Prolonged hospital stay (beyond anticipated for each patient) will be captured from hospital records/patient charts along with the reason and duration of such a stay
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8 days
|
Institutional discharge
Time Frame: 3 months
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This will be recorded from hospital records.
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3 months
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Cognitive Status
Time Frame: 3 months
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This will be captured using Mini Mental Status Examination (MMSE)
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3 months
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Mortality
Time Frame: 3 months
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This outcome will be captured as in-hospital mortality and up to 3 months after discharge.
|
3 months
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Adverse effects
Time Frame: 7 days
|
Observe significant sedation using Pasero Opioid-induced Sedation Scale (validated, commonly used) S=Sleep, easy to arouse
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7 days
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Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Nervous System Diseases
- Postoperative Complications
- Neurologic Manifestations
- Confusion
- Neurobehavioral Manifestations
- Neurocognitive Disorders
- Delirium
- Emergence Delirium
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Protective Agents
- Antioxidants
- Melatonin
Other Study ID Numbers
- 5506
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
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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