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Elder Surgery - Functional Recovery Following Beta Blockade

14. marts 2016 opdateret af: Icahn School of Medicine at Mount Sinai

This study proposes a prospective randomized study of elders undergoing elective major abdominal surgery to assess recovery following a unique anesthetic regimen incorporating a adrenergic receptor antagonist. The purposes of this study are to:

  1. to determine if using atenolol, a beta-blocker drug commonly used to treat high blood pressure and heart disease, as part of your anesthetic regimen will decrease complications that sometimes occur in elderly patients who are undergoing surgery and being given anesthesia.
  2. to see if it improves or quickens your recovery from anesthesia and surgery.
  3. to help investigators design better ways to administer anesthesia during surgery, especially in elderly patients, so that the complications and the time to recover from surgery and anesthesia can be decreased.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Increasing numbers of aged patients with multiple chronic diseases are undergoing major surgery. In the first third the last century, surgery was considered a desperate measure and patients greater than 50 years of age were felt incapable of sustaining the rigors of an inguinal hernia repair. Advances in anesthesia during the last century have allowed surgeons to develop an extraordinary array of procedures with excellent outcomes. Over 5.5 million patients aged 60 and over had major procedures in 1994. Centenarians routinely undergo surgical procedures.

Notwithstanding the enthusiasm for surgical treatments, morbidity, mortality, and recovery times for elderly patients are still substantially greater than for younger patients. Some morbidities, such as postoperative delirium and cognitive dysfunction appear to predominantly affect elderly patients. In a previous study, Dr. Valerie Lawrence, a co-investigator on this proposal, demonstrated that recovery from major surgery, as measured by the ability to accomplish standard activities of daily living, takes an average of 6 weeks while more complicated instrumental activities of daily living take an average of 3 months to return to baseline in elderly surgical patients. These data have profound implications for initiatives to control length of hospital stay, utilization of resources and costs of care. Evidence suggests that family members are requiring extra time off work to care for family members discharged earlier from hospitals.

Published reports and our preliminary data support the notion that intraoperative administration of adrenergic receptor antagonists (blockers) will improve functional recovery following surgery under general anesthesia. There is value in targeting functional status for elders undergoing surgery, because there is a direct relationship between functional status and utilization of health resources. Maximizing postoperative recovery, as opposed to minimizing morbidity and mortality, associated with surgical interventions in the elderly is consistent with the goal of prolonging "active life expectancy" expounded by Healthy People 2002.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

359

Fase

  • Fase 4

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Minnesota
      • Rochester, Minnesota, Forenede Stater, 55905
        • The Mayo Clinic
    • New York
      • New York, New York, Forenede Stater, 10029
        • Icahn School of Medicine at Mount Sinai
      • New York, New York, Forenede Stater, 10016
        • NYU School of Medicine

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

65 år og ældre (Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Patients 65 years of age or older
  • Patients undergoing elective major abdominal surgery (including but not limited to bowel, gastric, esophageal, pancreatic, gynecologic, urologic, and major intra-abdominal vascular procedures).
  • Procedures requiring general anesthesia
  • Laparoscopic-assisted major abdominal procedures
  • Procedures requiring a 2-3 day postoperative stay will be included.

Exclusion Criteria:

  • Unable to give informed consent to participate
  • Folstein Mini-Mental State Examination Score < 17
  • Gastrostomy tube placement
  • Laparoscopic cholecystectomy, laparoscopic Nissen fundoplication, or any type of Hernia repair
  • Appendectomy
  • Emergency surgery
  • Contraindications to adrenergic antagonists (third-degree heart block, decompensated congestive heart failure, active bronchospasm)
  • Surgery within the previous month
  • Major systemic infections
  • Allergies to or incompatibilities with any drug used in this study
  • Principle language other than English or Spanish
  • Residence greater than 100 miles away from Manhattan
  • Chronic debilitated state from which significant functional improvement following surgery is not anticipated (e.g., some nursing home residents, known metastatic cancer with poor prognosis)
  • Chronic opioid usage
  • Immunosuppression (subsequent opportunistic infections may obscure postoperative recovery).

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Atenolol
Atenolol given prior to and for up to 7 days after surgery
Medicin: Atenolol
Patients with a standing prescription for β-blockers will be continued on that medication. Pts not currently receiving a beta blocker will be given 50mg of atenolol on the morning of surgery, 50-100mg, twice per day, on the first postoperative day until postoperative day 7.
Andre navne:
  • Tenormin
Ingen indgriben: routine care
routine clinical care

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Long Term Functional Recovery
Tidsramme: at 3 weeks after surgery
self reported Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).
at 3 weeks after surgery

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Timed Up and Go test
Tidsramme: preoperatively
assesses basic functional mobility
preoperatively
Timed Up and Go test
Tidsramme: once at 7-10 days postoperatively
assesses basic functional mobility
once at 7-10 days postoperatively
Timed Up and Go test
Tidsramme: 1 month postoperatively
assesses basic functional mobility
1 month postoperatively
Timed Up and Go test
Tidsramme: 3 months postoperatively
assesses basic functional mobility
3 months postoperatively
Timed Up and Go test
Tidsramme: 6 months postoperatively
assesses basic functional mobility
6 months postoperatively
Hand grip strength
Tidsramme: preoperatively
performance-based measure of upper extremity strength.
preoperatively
Hand grip strength
Tidsramme: once at 7-10 days postoperatively
performance-based measure of upper extremity strength.
once at 7-10 days postoperatively
Hand grip strength
Tidsramme: 1 month postoperatively
performance-based measure of upper extremity strength.
1 month postoperatively
Hand grip strength
Tidsramme: 3 months postoperatively
performance-based measure of upper extremity strength.
3 months postoperatively
Hand grip strength
Tidsramme: 6 months postoperatively
performance-based measure of upper extremity strength.
6 months postoperatively

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Icahn School of Medicine at Mount Sinai

Samarbejdspartnere

National Institute on Aging (NIA)

Efterforskere

  • Ledende efterforsker: Jefrey H. Silverstein, MD, Icahn School of Medicine at Mount Sinai

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. september 2002

Primær færdiggørelse (Faktiske)

1. november 2007

Studieafslutning (Faktiske)

1. november 2007

Datoer for studieregistrering

Først indsendt

25. juli 2007

Først indsendt, der opfyldte QC-kriterier

25. juli 2007

Først opslået (Skøn)

26. juli 2007

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

16. marts 2016

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

14. marts 2016

Sidst verificeret

1. marts 2016

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • GCO 00-0100
  • AG018772 (Andet bevillings-/finansieringsnummer: National Institute on Aging (NIA))

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Kliniske forsøg med Postoperativ kognitiv dysfunktion

Kliniske forsøg med Atenolol

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Sponsorer og samarbejdspartnere

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Betingelser

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Narkotikainterventioner

Kosttilskud

Sponsor / samarbejdspartnere

Placeringer

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