- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05230641
Cardiac Autonomic Dysfunction and Perioperative Outcomes (CADPONS)
Cardiac Autonomic Dysfunction and Perioperative Outcomes After Neurosurgery
Study Overview
Detailed Description
Demographic and baseline clinical data including comorbid conditions and medication history will be collected. Baseline hemodynamic parameters - heart rate (HR) and systolic, diastolic, and mean blood pressure (SBP, DBP, MAP), rate pressure product (RPP) calculated as the product of HR and SBP and ANSindex (which informs the degree of dysautonomia and is derived noninvasively from a recording of 572 R wave to R wave intervals on an electrocardiogram) will be recorded in the immediate preoperative period.
Assessment of risk factors for preoperative CAD The investigators will explore potential risk factors for CAD in neurosurgical patients. The investigators postulate some known factors such as anxiety which will be diagnosed using the Visual analog scale for anxiety (VAS-A), age, gender, neurosurgical pathology, site-specific surgery (high cervical pathology, structural brain lesions, brainstem lesion, etc.), pre-existing diabetes mellitus and hypertension, and medications used for their treatment, higher American Society of Anesthesiology (ASA) grade, etc. to be associated with CAD in neurosurgical patients.
The investigators will explore the association between CAD and perioperative outcomes. Major Adverse Cardiac Events during Intra and postoperative period, in-hospital mortality, and duration of postoperative ICU and hospital stay.
Anesthesia will be administered as per the existing practice. Hemodynamic parameters HR, SBP, DBP, MAP at following time points - before and 1 and 2 min after induction of general anesthesia, before and at 1, 3, and 5 mins after tracheal intubation, and before and at 1, 3, and 5 mins after skull pin application, where applicable. Adverse hemodynamic events - persistent hypotension, arrhythmias, myocardial ischemia, cardiac failure, cardiac arrest) during the early (after anesthetic induction and before surgical incision), late (surgical incision to surgical closure) intraoperative period, recovery period (end of anesthesia to discharge from the operating room), post-anesthesia care unit (PACU) period (from arrival to discharge from PACU) and early postoperative period (up to 72 hours after surgery), neurological status (Glasgow Coma Scale) at hospital discharge, and duration of ICU and hospital stay will be recorded. The core temperature will be monitored during the intraoperative period to detect hypothermia (<35o C) or hyperthermia (>37.5 o C).
Sample size and statistical analysis Previous studies in the non-neurosurgical populations have determined the prevalence of CAD to vary from 25 to 73%. Considering an average prevalence of 50% in the neurosurgical population and a possible 5% margin of error, a sample size of 383 would be necessary for achieving a 95% confidence level. Hence the investigators plan to recruit 400 patients over a period of 1 year to account for potential dropouts from the study.
Data will be analyzed using Statistical Package for the Social Sciences (SPSS) or R software. Continuous variables will be compared by t-test, qualitative data by chi2 test, or Fisher exact test. Logistic regression will be used to identify the risk factors for cardiac autonomic dysfunction. A p < 0.05 will be considered statistically significant.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
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Karnataka
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Bangalore, Karnataka, India, 560029
- NIMHANS hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- aged between 18 and 80 years
- belonging to ASA grade 1-4
- scheduled for craniotomies or spinal surgeries under anesthesia
Exclusion Criteria:
- scheduled for redo procedures
- patients with preoperative arrhythmias and cardiac failure
- patients on preoperative inotropic support
- pregnant neurosurgical patients
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Prevalence of cardiac autonomic dysfunction in neurosurgical patients
Time Frame: Before anesthesia administration for surgery
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To study the prevalence of cardiac autonomic dysfunction in neurosurgical patients
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Before anesthesia administration for surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Risk factors of cardiac autonomic dysfunction in neurosurgical patients
Time Frame: Baseline
|
To identify risk factors of cardiac autonomic dysfunction in neurosurgical patients
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Baseline
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Impact of cardiac autonomic dysfunction on hemodynamic stress response
Time Frame: During anesthesia procedure for surgery
|
To assess the impact of cardiac autonomic dysfunction on hemodynamic stress response to laryngoscopy and intubation, anesthetic induction, and tracheal extubation
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During anesthesia procedure for surgery
|
Impact of cardiac autonomic dysfunction on hemodynamic instability
Time Frame: During surgery
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To assess the impact of cardiac autonomic dysfunction on incidence, duration and severity of intraoperative hypotension and hypertension and requirement of pharmacological intervention
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During surgery
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Impact of cardiac autonomic dysfunction on Major Adverse Cardiac Events
Time Frame: During and after surgery till discharge from the hospital, an average of 1 week
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To assess the impact of cardiac autonomic dysfunction on Major Adverse Cardiac Events namely, new onset myocardial ischemia, congestive cardiac failure, cardiac arrhythmias, cardiac arrest requiring resuscitation
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During and after surgery till discharge from the hospital, an average of 1 week
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Impact of cardiac autonomic dysfunction on temperature instability
Time Frame: During surgery
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To assess the impact of cardiac autonomic dysfunction on incidence of hypothermia and hyperthermia
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During surgery
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Impact of cardiac autonomic dysfunction on duration of hospital stay
Time Frame: After surgery till the time of discharge from the hospital, an average of 1 week
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To assess the impact of cardiac autonomic dysfunction on duration of ICU and hospital stay
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After surgery till the time of discharge from the hospital, an average of 1 week
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Impact of cardiac autonomic dysfunction on in-hospital mortality
Time Frame: After surgery till the time of discharge from the hospital, an average of 1 week
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To assess the impact of cardiac autonomic dysfunction on in-hospital mortality
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After surgery till the time of discharge from the hospital, an average of 1 week
|
Collaborators and Investigators
Investigators
- Principal Investigator: Sangeetha RP, National Institute of Mental Health and Neuro Sciences, India
Publications and helpful links
General Publications
- Padley JR, Ben-Menachem E. Low pre-operative heart rate variability and complexity are associated with hypotension after anesthesia induction in major abdominal surgery. J Clin Monit Comput. 2018 Apr;32(2):245-252. doi: 10.1007/s10877-017-0012-4. Epub 2017 Mar 14.
- Chakraborty T, Kramer CL, Wijdicks EFM, Rabinstein AA. Dysautonomia in Guillain-Barre Syndrome: Prevalence, Clinical Spectrum, and Outcomes. Neurocrit Care. 2020 Feb;32(1):113-120. doi: 10.1007/s12028-019-00781-w.
- McGrane S, Atria NP, Barwise JA. Perioperative implications of the patient with autonomic dysfunction. Curr Opin Anaesthesiol. 2014 Jun;27(3):365-70. doi: 10.1097/ACO.0000000000000072.
- Keyl C, Lemberger P, Palitzsch KD, Hochmuth K, Liebold A, Hobbhahn J. Cardiovascular autonomic dysfunction and hemodynamic response to anesthetic induction in patients with coronary artery disease and diabetes mellitus. Anesth Analg. 1999 May;88(5):985-91. doi: 10.1097/00000539-199905000-00004.
- Polderman JAW, Sperna Weiland NH, Klaver MH, Biginski J, Horninge M, Hollmann MW, DeVries JH, Immink RV, Preckel B, Hermanides J. The prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study. PLoS One. 2018 Nov 26;13(11):e0207384. doi: 10.1371/journal.pone.0207384. eCollection 2018.
- Hogan AM, Luck C, Woods S, Ortu A, Petkov S. The Effect of Orthostatic Hypotension Detected Pre-Operatively on Post-Operative Outcome. J Am Geriatr Soc. 2021 Mar;69(3):767-772. doi: 10.1111/jgs.16966. Epub 2020 Dec 11.
- Mustafa HI, Fessel JP, Barwise J, Shannon JR, Raj SR, Diedrich A, Biaggioni I, Robertson D. Dysautonomia: perioperative implications. Anesthesiology. 2012 Jan;116(1):205-15. doi: 10.1097/ALN.0b013e31823db712.
- Cheshire WP, Freeman R, Gibbons CH, Cortelli P, Wenning GK, Hilz MJ, Spies JM, Lipp A, Sandroni P, Wada N, Mano T, Kim HA, Kimpinski K, Iodice V, Idiaquez J, Thaisetthawatkul P, Coon EA, Low PA, Singer W. Corrigendum to "Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology" [Clin. Neurophysiol. 132(2) (2021) 666-682]. Clin Neurophysiol. 2021 May;132(5):1194. doi: 10.1016/j.clinph.2021.02.006. Epub 2021 Mar 6. No abstract available.
- Farbood A, Sahmeddini MA, Bayat S, Karami N. The effect of preoperative depression and anxiety on heart rate variability in women with breast cancer. Breast Cancer. 2020 Sep;27(5):912-918. doi: 10.1007/s12282-020-01087-y. Epub 2020 Apr 7.
- Abhishekh HA, Nisarga P, Kisan R, Meghana A, Chandran S, Trichur Raju, Sathyaprabha TN. Influence of age and gender on autonomic regulation of heart. J Clin Monit Comput. 2013 Jun;27(3):259-64. doi: 10.1007/s10877-012-9424-3. Epub 2013 Jan 8.
- Katsanos AH, Korantzopoulos P, Tsivgoulis G, Kyritsis AP, Kosmidou M, Giannopoulos S. Electrocardiographic abnormalities and cardiac arrhythmias in structural brain lesions. Int J Cardiol. 2013 Jul 31;167(2):328-34. doi: 10.1016/j.ijcard.2012.06.107. Epub 2012 Jul 16.
- Ideguchi M, Kajiwara K, Yoshikawa K, Sadahiro H, Nomura S, Fujii M, Suzuki M. Characteristics of intraoperative abnormal hemodynamics during resection of an intra-fourth ventricular tumor located on the dorsal medulla oblongata. Neurol Med Chir (Tokyo). 2013;53(10):655-62. doi: 10.2176/nmc.oa2012-0401. Epub 2013 Sep 27.
- Knuttgen D, Weidemann D, Doehn M. Diabetic autonomic neuropathy: abnormal cardiovascular reactions under general anesthesia. Klin Wochenschr. 1990 Dec 4;68(23):1168-72. doi: 10.1007/BF01815272.
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 (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
Other Study ID Numbers
- NIMHANS/33 IEC(BS&NS DIV)/2021
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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