The Effect of Anesthesia on Cerebral Oxygenation

February 17, 2021 updated by: Ali AKDOĞAN, Karadeniz Technical University

The Effect of Different Anesthesia Techniques on Cerebral Oxygenation in Thoracic Surgery

One-lung ventilation (OLV) may cause negative changes in the oxygenation of cerebral tissue which results in postoperative cognitive dysfunction. The aim of this prospective study was to compare the potential effects of TIVA and inhalation general anesthesia techniques on cerebral tissue oxygenation and postoperative cognitive functions in patients receiving one-lung ventilation in thoracic surgery

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

One-lung ventilation (OLV) is a commonly used technique in thoracic surgeries. In thoracic surgeries performed with OLV, there may be changes in cerebral tissue oxygenation depending on both patient position and anesthetic technique. The effect of cerebral hypoxia on postoperative cognitive functions is controversially. Despite the ISPOCD1 study in which concluded that there were no relationship between the cerebral hypoxy and postoperative cognitive dysfunction (POCD) regional cerebral oxygen saturation decrements during surgery are listed among the POCD When OLV begins, alveolar hypoxia and arteriovenous shunt of deoxygenated blood occur in the dependant lung. And then, hypoxic pulmonary vasoconstriction (HPV) in non-ventilated lung segments occurs with increased mechanical stress. This event lead to significant physiological changes in cardiac output and pulmonary and systemic pressures In OLV, the propofol-based total intravenous anesthesia (TIVA) and inhalation general anesthesia techniques are frequently used. Recent studies have shown that unlike inhalational anesthetics, propofol does not suppress HPV, indeed increases it (Inhalational anesthetic agents reduce cardiac output more than oxygen consumption, causing a decrease in mixed venous partial pressure of oxygen, which stimulates hypoxic pulmonary vasoconstriction . Studies have shown significant reductions in cerebral oxygen saturation in thoracic surgery as a result of severe oxidative stress due to prolonged OLV and hypoxemia due to decreased functional residual capacity of the ventilated lung in the lateral decubitus position Cerebral oximetry is a method used to monitor the cerebral oxygen distribution-consumption balance and regional oxygen saturation (rSO2) in a limited area of the frontal cortex by noninvasively and continuously combining arterial and venous oxygen saturation signals of near-infrared spectroscopy (NIRS), which is a technique developed in the 1970s. Thanks to this method, perioperative physiological conditions, optimal tissue oxygenation and end-organ functions can be interpreted The aim of this prospective study was to compare the potential effects of TIVA and inhalation general anesthesia techniques on cerebral tissue oxygenation and postoperative cognitive functions in patients receiving one-lung ventilation in thoracic surgery

Study Type

Observational

Enrollment (Actual)

30

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

  • Turkey
      • Trabzon, Turkey, 61080
        • Karadeniz Technical University

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

14 years to 76 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

Patients who would undergo thoracic surgery with one-lung ventilation (OLV)

Description

Inclusion Criteria:

  • Patients in American Society of Anesthesiology (ASA) classification I and II
  • Patients who would undergo thoracic surgery with one-lung ventilation (OLV)
  • thoracic surgeries with one-lung ventilation (OLV) that will take at least 45 minutes

Exclusion Criteria:

  • Patients in ASA classification III and higher
  • Emergency surgery
  • Patients with known allergy to drugs used in the study
  • Patients in New York Heart Association classification III-IV
  • severe metabolic, renal, hepatic, central nervous system diseases, alcohol or drug addiction
  • multiple trauma, coagulapathy, cerebral disease, dementia, hearing impairment and imperception
  • severe obesity (a body mass index (BMI) of ≥ 35)
  • patients with a peripheral oxygen saturation below 90 during one lung ventilation

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

  • Observational Models: Case-Control
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Group Propofol
anesthesia was maintained with TIVA (intravenous 125-250 µg/kg/min propofol + 0.1-0.25 µg/kg/min remifentanil infusion)
Drug: Propofol
BIS values were arranged 40-60 until the end of operation, In case of tachycardia or hypertension the opioid dose was reduced, in case of bradycardia or hypertension the opioid dose was increased
Other Names:
  • Remifentanil
Group Sevoflurane
anesthesia was maintained with inhalation (sevoflurane concentration of 1-2% in 50-50% O2-air mixture).
Drug: Sevoflurane
Sevoflurane %2-3 for general anesthesia maintenance, BIS values were arranged 40-60 until the end of operation, In case of tachycardia or hypertension the opioid dose was reduced, in case of bradycardia or hypertension the opioid dose was increased

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Near Infrared Spectroscopy
Time Frame: Duration of surgery
Cerebral oxygen saturation as measured by Near Infrared Spectroscopy
Duration of surgery
Mini mental state examination (MMSE)
Time Frame: 3 to 24 hours postoperative period
Mini mental state examination (MMSE) to evaluate patients' cognitive functions
3 to 24 hours postoperative period

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
mean arterial pressure
Time Frame: Duration of surgery
The effect of anesthetics on mean arterial pressure
Duration of surgery
heart rate
Time Frame: Duration of surgery
The effect of anesthetics on heart rate
Duration of surgery
bispectral index
Time Frame: Duration of surgery
The effects of sevoflurane and desflurane on bispectral index
Duration of surgery

Collaborators and Investigators

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

Sponsor

Karadeniz Technical University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Actual)

March 1, 2017

Primary Completion (Actual)

June 15, 2019

Study Completion (Actual)

January 20, 2020

Study Registration Dates

First Submitted

February 10, 2021

First Submitted That Met QC Criteria

February 17, 2021

First Posted (Actual)

February 18, 2021

Study Record Updates

Last Update Posted (Actual)

February 18, 2021

Last Update Submitted That Met QC Criteria

February 17, 2021

Last Verified

February 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2013/21

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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