- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04320082
Alteration of Blood-Brain-Barrier Permeability at Loss of Consciousness in Delirious Patients Recorded With Direct-Current Electroencephalography (ACDC)
Study Overview
Status
Conditions
Detailed Description
In order to study the intraoperative DC-EEG signatures of elderly patients coupled with lab data to evaluate the role of the age-dependent blood-brain barrier (BBB) dysfunction in general anesthesia and its meaning in POD pathophysiology following protocol will be followed:
- On the day of the surgery the 21 DC-EEG sintered Ag/AgCl (silver chloride) electrodes will be placed before the start of anesthesia following the 10-20-system.
- The first blood sample will be collected via the routinely placed intravenous catheter.
- During the induction of anesthesia special care will be given to the exact time of loss of consciousness (LOC), defined with the suppression of the lid closure reflex.
- Markers will be set at important time points of the anesthetic care (Baseline, start of analgesia/anesthesia, LOC, intubation, beginning of surgical procedure, end of anesthesia, regain of consciousness, extubation, admission recovery room).
- Shortly after consciousness has vanished (5-10 minutes), a second blood sample will be drawn.
- The DC-EEG recording will last until one hour after arrival at the recovery room, during which NuDesc score will be assessed every 15 minutes.
- A third blood sample is to be collected in the recovery room. In the five days following surgery patients will be visited in the morning and in the evening to screen delirious symptoms with the help of standardized scores (NuDesc, DSM V, DDS). If patients are staying on the intensive care unit the CAM-ICU will be used.
Blood sample analysis will include blood cells count, electrolytes, inflammatory markers, cholesterols, proteins, structural BBB markers and markers of neuronal damage.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Claudia Spies, MD. Prof.
- Phone Number: +49 30 450 55 11 02
- Email: claudia.spies@charite.de
Study Contact Backup
- Name: Claudia Spies, MD, Prof.
- Phone Number: 49 30 450 55 11 02
- Email: claudia.spies@charite.de
Study Locations
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Berlin, Germany, 13353
- Recruiting
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin
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Contact:
- Claudia Spies, MD. Prof.
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Sub-Investigator:
- Susanne Koch, MD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Elderly Cohort: Patients >70 undergoing elective orthopaedic or trauma surgery under general anaesthesia.
Young cohort: Patients between 18 and 30 undergoing elective orthopaedic or trauma surgery under general anaesthesia.
Description
Inclusion Criteria:
- Patients aged >70 years OR between 18 and 30
- Planned operation time >1 hour
- Expected hospital treatment period of 5 days,
- Anesthesia induction, anesthesia maintenance with either Propofol or an inhalative anesthetic agent as Sevoflurane or Desflurane,
- The ability to give informed consent
Exclusion Criteria:
- Age under 18 or between 31 and 69
- Patients with a history of neurological or psychiatric disorders
- Planned neurosurgery
- Current medication of tranquilizers / antidepressants
- Isolation of patients with multi-resistant Bacteria
- Inability of the patients to speak and/or read German
- Intraoperative use of ketamine, N²O, Etomidate or Dexmedetomidine
- Participation in a prospective interventional trial
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
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Elderly cohort
Patients >70 undergoing elective orthopaedic or trauma surgery under general anaesthesia.
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Young cohort
Patients between 18 and 30 undergoing elective orthopaedic or trauma surgery under general anaesthesia.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
1. DC-Shift (µV/sec) in the perioperative DC-EEG.
Time Frame: From the beginning of general anaesthesia to one hour after regain of consciousness
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Full-brain DC-EEG with 21 electrodes placed preoperatively following the 10/20-System and recording until one hour after regain of consciousness.
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From the beginning of general anaesthesia to one hour after regain of consciousness
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of Postoperative Delirium
Time Frame: Patients will be follow until hospital discharge, or maximal until postoperative day 5
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Postoperative Delirium is defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and/or as ≥ 2 cumulative points in the nursing Delirium Screening Scale (Nu-DESC) and/or a positive Confusion Assessment Method (CAM) and/or Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score and/or patient chart review that shows descriptions of Delirium.
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Patients will be follow until hospital discharge, or maximal until postoperative day 5
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Additional perioperative DC-EEG signatures: morphology, polarity (positive/negative), amplitude (µV)
Time Frame: From the beginning of general anaesthesia to one hour after regain of consciousness
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Full-brain DC-EEG with 21 electrodes placed preoperatively following the 10/20-System and recording until one hour after regain of Consciousness.
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From the beginning of general anaesthesia to one hour after regain of consciousness
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DC-EEG signatures in young (18-30) vs. elderly (>70) patients
Time Frame: From the beginning of general anaesthesia to one hour after regain of consciousness
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Full-brain DC-EEG with 21 electrodes placed preoperatively following the 10/20-System and recording until one hour after regain of consciousness
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From the beginning of general anaesthesia to one hour after regain of consciousness
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Analysis of pre-, intra- and postoperative blood parameters
Time Frame: : From shortly before the beginning of general anaesthesia to maximum one hour after arrival in the recovery room
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Blood samples will be drawn before the start of general anesthesia, shortly after loss of consciousness and in the recovery room.
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: From shortly before the beginning of general anaesthesia to maximum one hour after arrival in the recovery room
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Peri-operative, full-brain overall EEG band power
Time Frame: Up to the end of stay in the recovery room
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Full-brain EEG recording with surface Ag/AgCl electrodes Spectral analysis by Matlab Code/Lab Chart
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Up to the end of stay in the recovery room
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Burst suppression duration
Time Frame: During anesthesia procedure
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Full-brain EEG recording with surface electrodes, raw EEG analysis
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During anesthesia procedure
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Duration of Delirium
Time Frame: Participants will be followed for the duration of hospital stay, or maximal until postoperative day 5
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Diagnostic and Statistical Manual of Mental Disorders (DSM-V); Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Confusion Assessment Method (CAM), Chart Review
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Participants will be followed for the duration of hospital stay, or maximal until postoperative day 5
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Intensive care unit length of stay
Time Frame: Participants will be followed for the duration of intensive care unit stay, an expected average of 5 days
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The stay is measured in days.
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Participants will be followed for the duration of intensive care unit stay, an expected average of 5 days
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Hospital length of stay
Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 7 days
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The stay is measured in days.
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Participants will be followed for the duration of hospital stay, an expected average of 7 days
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Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- ACDC
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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