- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06036095
Total Intravenous Versus Inhalational Anesthesia- A Geriatric Anesthesia Study (TIVA GAS)
Optimizing Anesthesia to Prevent Postoperative Cognitive and Functional Decline in Older Adults: A Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Aim 1: Determine the effects of intravenous vs. inhalational anesthesia on incidence of postoperative delirium and postoperative cognitive dysfunction in older adults undergoing non-cardiac surgery.
Hypothesis: Intravenous anesthesia is associated with a lower incidence of POD and POCD compared to inhalational anesthesia.
Primary outcomes: Incidence of postoperative delirium and postoperative cognitive dysfunction Secondary outcomes: delirium severity, delirium duration Aim 2: Determine the effects of intravenous vs. inhalational anesthesia on incidence of postoperative functional decline and patient-reported outcomes in older adults undergoing non-cardiac surgery.
Hypothesis: Intravenous anesthesia is associated with a lower incidence of postoperative functional decline and improved patient-reported outcomes (PROs) compared to inhalational anesthesia.
Primary outcomes: Incidence of postoperative functional decline; patient-reported outcome scores Aim 3: Determine the effects of intravenous vs. inhalational anesthesia on blood phosphorylated tau 181 (p-tau181) and other blood biomarkers in older adults undergoing non-cardiac surgery.
Hypothesis 1: Elevated preop blood p-tau181 is associated with increased POD and POCD; Hypothesis 2: Postoperative increase in blood p-tau181 is greater with GAS relative to IV; Hypothesis 3: Postop increases in blood biomarkers of neuroinflammation and AD pathology are greater with GAS relative to IV.
Primary outcomes: preoperative levels of blood p-tau181 and change in levels from preoperative baseline to postoperative.
Secondary outcomes: Other candidate biomarkers include those previously implicated in POD or POCD: p-tau217, Aβ,54 NF-L,55 High mobility group box protein 1 (HMGB1),60 S100β,76 interleukin (IL)-6,58 IL-1β,22 IL-10,46 tumor necrosis factor (TNF)-α,22 CCL2,62 and glial fibrillary acidic protein (GFAP).77
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Kimberly N. Chun, BS
- Phone Number: 503-494-7437
- Email: chunk@ohsu.edu
Study Contact Backup
- Name: Sarah L. Feller, BS
- Phone Number: 503-494-6233
- Email: fellersa@ohsu.edu
Study Locations
-
-
Oregon
-
Portland, Oregon, United States, 97239
- Recruiting
- Oregon Health & Science University
-
Contact:
- Sarah Feller, BS
- Email: fellersa@ohsu.edu
-
Contact:
- Kimberly Chun, BS
- Email: chunk@ohsu.edu
-
Principal Investigator:
- Katie Schenning, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion criteria:
- Men and women ≥ 70 years
- Sufficient vision and hearing to complete all tests
- Proficient in spoken and written English
- Scheduled for elective, inpatient, noncardiac surgery, expected to last at least 120 minutes requiring general anesthesia
Exclusion criteria:
- Urgent or emergent surgery
- Diagnosed dementia (or MoCA<19)
- History of Parkinson's disease, major psychiatric disease (Schizophrenia), or severe traumatic brain injury
- Ongoing alcohol or substance abuse (per DSM V criteria)
- Allergy to propofol or sevoflurane
- Personal or family history of malignant hyperthermia
- Planned postoperative intubation
- Brain surgery
- Surgery requiring TIVA or GAS (i.e. cases involving neuromonitoring)
- Surgical procedure requiring general anesthetic occurring within 3 months (before or after) surgical date
- Any patient or perioperative factor considered a contraindication to randomization to either experimental group by the surgeon or anesthesiologist.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Inhalational Anesthesia
Inhalational maintenance of anesthesia group using sevoflurane
|
Inhalational maintenance of anesthesia group using sevoflurane
Other Names:
|
Active Comparator: Intravenous Anesthesia
Intravenous maintenance of anesthesia group using propofol
|
Intravenous maintenance of anesthesia group using propofol
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Effects of intravenous vs. inhalational anesthesia on incidence of postoperative delirium in older surgical patients with the 3D-Confusion Assessment Method (3D-CAM-S) and the CAM-ICU-7.
Time Frame: through postoperative day 3
|
Incidence of postoperative delirium with the 3D-Confusion Assessment Method (3D-CAM) in non-intubated patients and the CAM-ICU-7 in intubated patients.
Delirium will be assessed postoperative in PACU and twice daily on postoperative days 1-3 while the patient is in the hospital.
|
through postoperative day 3
|
Determine the effects of intravenous vs. inhalational anesthesia on the incidence of postoperative neurocognitive disorder in older adults undergoing non-cardiac surgery using neuropsychiatric composite score.
Time Frame: Change from preoperative baseline to one year.
|
Postoperative neurocognitive disorder.
Change from preoperative baseline cognitive dysfunction using neuropsychiatric composite score.
Battery of neuropsychological tests: Animal Verbal Fluency Test, Trail Making Test A & B, Digit Symbol Test, Logical Memory Immediate & Delayed Recall, and CERAD Word List Immediate and Delayed recall.
MASQ will be used for subjective cognitive decline.
Functional status will be measured by FAQ.
|
Change from preoperative baseline to one year.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Determine the effects of intravenous vs. inhalational anesthesia on incidence of delirium duration (days) and severity, measured by 3D-CAM-S, and CAM-ICU-7 in older adults undergoing non-cardiac surgery.
Time Frame: through postoperative day 3
|
delirium severity and duration.
Delirium will be assessed postoperative in PACU and twice daily on postoperative days 1-3.
|
through postoperative day 3
|
Effects of intravenous vs. inhalational anesthesia on levels of blood phosphorylated tau 181 (p-tau181) in older surgical patients.. Change from preoperative baseline blood p-tau181 to postoperative day 1, 3 months and 12 months.
Time Frame: Change from baseline through one year.
|
change in levels of preoperative levels of blood p-tau181 from preoperative baseline to 12 months postoperative
|
Change from baseline through one year.
|
Determine the effects of intravenous vs. inhalational anesthesia on incidence of postoperative functional decline using ADL, FAQ, and FRAIL in older adults undergoing non-cardiac surgery.
Time Frame: Change from baseline through one year
|
Incidence of postoperative functional decline.
Change from preoperative baseline postoperative functional decline to postoperative 12 months.
|
Change from baseline through one year
|
Determine the effects of intravenous vs. inhalational anesthesia on patient-reported outcomes (PROMIS-29+2 Profile v2.1) in older adults undergoing non-cardiac surgery.
Time Frame: Change from baseline through one year
|
patient-reported outcome scores, PROMIS-29+2 Profile v2.1 (PROPr) assesses patient-reported measures of anxiety, depression, fatigue, pain interference, physical function, sleep disturbance, participation in social activities, pain, and cognition.
Measured at preoperative baseline, 3 months postoperatively, and 12 months postoperatively
|
Change from baseline through one year
|
Collaborators and Investigators
Investigators
- Principal Investigator: Katie J. Schenning, MD, Oregon Health and Science University
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
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Nervous System Diseases
- Postoperative Complications
- Neurologic Manifestations
- Confusion
- Neurobehavioral Manifestations
- Cognition Disorders
- Delirium
- Cognitive Dysfunction
- Postoperative Cognitive Complications
- Emergence Delirium
- Neurocognitive Disorders
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Anesthetics, Intravenous
- Anesthetics, General
- Platelet Aggregation Inhibitors
- Hypnotics and Sedatives
- Anesthetics, Inhalation
- Anesthetics
- Propofol
- Sevoflurane
Other Study ID Numbers
- STUDY00024667
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
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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