- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04891458
Effect of Intraoperative Sedation on PND in Elderly Patients
May 17, 2021 updated by: Hebei Medical University Third Hospital
Effect of Intraoperative Sedation on Perioperative Neurocognitive Disorders in Elderly Patients
The aim of this study was to identify the effects of different depths of sedation and choices of sedative drugs on perioperative neurocognitive disorders in the elderly patients receiving hip surgery under spinal anesthesia.
Study Overview
Status
Not yet recruiting
Conditions
Intervention / Treatment
- Drug: Patients received lighter sedation with propofol after spinal anesthesia.
- Drug: Patients received heavier sedation with propofol after spinal anesthesia
- Drug: Patients received lighter sedation with dexmedetomidine after spinal anesthesia
- Drug: Patients received heavier sedation with dexmedetomidine after spinal anesthesia.
Detailed Description
PND is a complication of the central nervous system after anesthesia and surgery which is considered to be a common complication in elderly patients.
Age is an independent risk factor for the occurrence of PND.
Prolonged hospitalization, incapacity and long duration of PND aggravate the economic burden of individuals, families and society.
The pathogenesis of PND is still unclear.
Recent studies suggest that the blood-brain barrier (BBB) is damaged by surgery or anesthesia, which causes the activation of inflammatory factors such as TNF α and NF - κ B, and then leads to the decline of hippocampus cognitive function.
In recent years, it has been found that dexmedetomidine can reduce the brain injury during ischemia-reperfusion and reduce the occurrence of PND.
BDNF is a neurotrophin, which plays an important role in the growth, differentiation, synaptic plasticity, survival and repair of neurons.
Studies have shown that the decrease of BDNF concentration is related to PND, which can be used as an index to evaluate brain injury and predict PND.
S100 β protein is a specific low molecular calcium binding protein of nervous system which can be increased early after brain injury, so it can be used to reflect the severity and prognosis of brain injury and predict PND.In this randomized controlled trial, investigators will compare the incidence of PND in hip surgery with four intraoperative sedation regimens.
After spinal anesthesia, the following sedation regimen will be used: (1) Intravenous infusion of propofol to make patients receive lighter sedation(modified observer's assessment of alertness/sedation score[MOAA/S],0-2) (2) Intravenous infusion of propofol to make patients receive heavier sedation(MOAA/S,3-5) (3)After a bolus of dexmedetomidine, intravenous infusion of dexmedetomidine to make patients receive lighter sedation(MOAA/S,0-2) (4) After a bolus of dexmedetomidine, intravenous infusion of dexmedetomidine to make patients receive heavier sedation(MOAA/S,3-5). 3ml venous blood samples were collected before anesthesia (T0), 1 h after operation (T1), 1 day after operation (T2) and 7 days after operation (T3).
Plasma samples were collected after centrifugation and the concentrations of BDNF and S100 β were determined by ELISA.
After 7days of surgery, PND is screened by CAM with a trained research assistant everyday, and CAM positive patients are judged by a qualified psychiatrist to meet DSM-V criteria until the patient is discharged.
For patients with PND, the delirium rating scale (DRS) was used to assess the degree of delirium.
Study Type
Interventional
Enrollment (Anticipated)
160
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Shuang Zhao, PhD
- Phone Number: +86 13613210924
- Email: zhaoshuang810924@163.com
Study Contact Backup
- Name: Shuxing Zhu, M.D
- Phone Number: +86 17600129361
- Email: 524176941@qq.com
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
65 years and older (Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Acquisition of informed consent,
- Patients with hip fracture surgery under spinal anesthesia,
- Grade I to III based on American Society of Anesthesiologists ASA classification,
- Age ≥65.
Exclusion Criteria:
- There was a history of cardiovascular and cerebrovascular adverse events in the past six months, including myocardial infarction, angina pectoris, severe arrhythmia, stroke or transient ischemic attack (TIA)
- Heart failure (NYHA III / IV and / or LVEF < 30%)
- Bradycardia
- Respiratory failure (need oxygen)
- Glasgow Coma Scale ≤ 14 points
- Severe hepatic and renal insufficiency (child Pugh grade B or C)
- Preoperative cognitive impairment or sedative drugs (benzodiazepines, etc.).
- Adverse reactions such as allergy to dexmedetomidine or / or propofol
- Preoperative bilateral hip fracture or other trauma need simultaneous operation
- Contraindications of spinal anesthesia
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
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Patients received lighter sedation with propofol after spinal anesthesia
Continuous infusion of propofol at a rate of 1.0-4.0mg/kg
per hour until the end of surgery to achieve MOAA/S 0-2.
|
MOAA/S 0-2.
|
Experimental: Patients received heavier sedation with propofol after spinal anesthesia
Continuous infusion of propofol at a rate of 1.0-4.0mg/kg
per hour until the end of surgery to achieve MOAA/S 3-5.
|
MOAA/S 3-5.
|
Experimental: Patients received lighter sedation with dexmedetomidine after spinal anesthesia.
Continuous infusion of dexmedetomidine at a rate of 0.2-0.7 mcg/ kg per hour until the end of surgery to achieve MOAA/S 0-2.
|
MOAA/S 0-2.
|
Experimental: Patients received heavier sedation with dexmedetomidine after spinal anesthesia.
Continuous infusion of dexmedetomidine at a rate of 0.2-0.7 mcg/ kg per hour until the end of surgery to achieve MOAA/S 3-5.
|
MOAA/S 3-5.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
postoperative delirium
Time Frame: 1 week
|
Postoperative delirium is assessed with the Confusion Assessment Method and in accordance with the the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnostic criteria for delirium,each postoperative day until discharge. Delirium severity is scored using the long Confusion Assessment Method Severity score. |
1 week
|
Change from Cognitive state in 1 week.
Time Frame: 1 week
|
Cognitive state is measured with the Beijing version of Montreal Cognitive Assessment preoperatively,on the first day and the seventh day after surgery.
A score of ≥26 is considered normal in Montreal Cognitive Assessment,with the maximum score of 30 points.
The lower the score, the worse the cognitive status.
|
1 week
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Inflammatory biomarker level in blood
Time Frame: before anesthesia (T0), 1 hour after operation (T1), 1 day after operation (T2) and 7 days after operation (T3)
|
BDNF、S100 β 、NF-κB、TNF-α
|
before anesthesia (T0), 1 hour after operation (T1), 1 day after operation (T2) and 7 days after operation (T3)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Study Chair: Shuang Zhao, PhD, Third Hospital of Hebei Medical University Department of Anesthesiology
- Study Director: Shuxing Zhu, M.D, Third Hospital of Hebei Medical University Department of Anesthesiology
- Principal Investigator: Xiuli Wang, PhD, Third Hospital of Hebei Medical University Department of Anesthesiology
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 (Anticipated)
July 1, 2021
Primary Completion (Anticipated)
June 30, 2022
Study Completion (Anticipated)
July 31, 2022
Study Registration Dates
First Submitted
May 13, 2021
First Submitted That Met QC Criteria
May 17, 2021
First Posted (Actual)
May 18, 2021
Study Record Updates
Last Update Posted (Actual)
May 18, 2021
Last Update Submitted That Met QC Criteria
May 17, 2021
Last Verified
May 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Intravenous
- Anesthetics, General
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Hypnotics and Sedatives
- Anesthetics
- Propofol
- Dexmedetomidine
Other Study ID Numbers
- IOSPND
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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