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Impact Dexmedetomidine on Postoperative Delirium in Patients After Intracranial Operation for Brain Tumor

10. januar 2021 opdateret af: Jian-Xin Zhou, Capital Medical University

Impact of Prophylactic Use of Dexmedetomidine on Postoperative Delirium in Patients After Intracranial Operation for Brain Tumor: a Pilot Randomized Controlled Trial

Postoperative delirium is one of the most common serious complications after major surgery and is associated with undesirable consequences. Prevention of postoperative delirium is recommended in the clinical guidelines and consensus statements. Dexmedetomidine, a highly selective α2-adrenergic receptor agonist, has been investigated as a pharmacological intervention to prevent postoperative delirium. Several randomized controlled trials have shown that prophylactic use of low-dose dexmedetomidine may decrease the incidence of postoperative delirium in patients after cardiac and non-cardiac operations. However, neurosurgical patients are often excluded from previous studies due to potential consciousness and cognition impairment. The investigators design this pilot study aiming to clarify the feasibility and safety of use of low-dose dexmedetomidine for prevention of postoperative delirium in patients after intracranial operation for brain tumor.

Studieoversigt

Detaljeret beskrivelse

Postoperative delirium is one of the most common serious complications after major surgery and is associated with undesirable consequences. Prevention of postoperative delirium is recommended in the clinical guidelines and consensus statements. Dexmedetomidine, a highly selective α2-adrenergic receptor agonist, has been investigated as a pharmacological intervention to prevent postoperative delirium. Several randomized controlled trials have shown that prophylactic use of low-dose dexmedetomidine (0.1 ug/kg/hour without loading infusion) may decrease the incidence of postoperative delirium in patients after cardiac and non-cardiac operations. However, neurosurgical patients are often excluded from previous studies due to potential consciousness and cognition impairment. The investigators design this pilot randomized controlled trial aiming to clarify the feasibility and safety of use of low-dose dexmedetomidine for prevention of postoperative delirium in patients after intracranial operation for brain tumor.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

60

Fase

  • Fase 4

Kontakter og lokationer

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

Studiesteder

    • Beijing
      • Beijing, Beijing, Kina, 100050
        • ICU, Beijing Tiantan Hospital, Capital Medical University

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

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Adult patients after elective intracranial operation for brain tumor under general anesthesia and who are admitted to the ICU directly from the operating room or postoperative care unit.

Exclusion Criteria:

  • age under 18 years;
  • admitted to the ICU after 22:00 PM;
  • medical records documented preoperative history of mental or cognitive disorders including schizophrenia, epilepsy, Parkinsonism, or dementia;
  • medical records documented inability to communicate in the preoperative period due to coma or language barrier;
  • history of drug abuse of psychoactive and anesthetic drugs;
  • known preoperative severe bradycardia (lower than 50 beats/min), sick sinus syndrome, second- or third-degree atrioventricular block, or left ventricular ejection fraction lower than 30%;
  • serious hepatic dysfunction defined as Child-Pugh class C;
  • severe renal dysfunction requiring renal replacement therapy before the surgery;
  • allergies to ingredients or components of dexmedetomidine hydrochloride;
  • American Society of Anesthesiologists classification of IV to VI;
  • moribund condition with low likelihood of survival for more than 24 hours;
  • pregnancy or lactation women;
  • current enrollment in another clinical trial;
  • refusal to participate.

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: Firedobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Placebo komparator: Normal saltvandsgruppe
Kontinuerlig intravenøs infusion af normalt saltvand med en hastighed på 0,025 ml/kg/time startede umiddelbart efter indskrivning indtil kl. 08:00 på den postoperative dag ét.
Normal saline is also diluted with normal saline to 50 ml and is continuously intravenous infused at a rate of 0.025 ml/kg/hour, which is the same with the dexmedetomidine group. The intravenous infusion begins immediately after enrollment until 08:00 AM on the postoperative day one.
Andre navne:
  • 0,9% natriumchlorid
Eksperimentel: Dexmedetomidine group
Continuously intravenous infusion of dexmedetomidine hydrochloride at a rate of 0.1 μg/ kg/hour (0.025 ml/kg/hour) started immediately after enrollment until 08:00 AM on the postoperative day one.
Dexmedetomidinhydrochlorid (200 μg/2 ml) fortyndes med normalt saltvand til 50 ml og infunderes kontinuerligt intravenøst ​​med en hastighed på 0,025 ml/kg/time (dexmedetomidin 0,1 μg/kg/time). Den intravenøse infusion begynder umiddelbart efter indskrivning indtil kl. 08.00 på den postoperative dag ét.
Andre navne:
  • Dexmedetomidin hydrochlorid

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of study agent interruption during the study
Tidsramme: From the start of study agent infusion to postoperative day 1
Predicted adverse events in the present study included bradycardia (defined as heart rate lower than 50 beats/min), hypotension (defined as systolic blood pressure lower than 90 mmHg), tachycardia (defined as heart rate greater than 100 beats/min), hypertension (defined as systolic blood pressure greater than 160 mmHg) and hypoxemia (defined as pulse oxygen saturation lower than 90%). The treatment of adverse events was determined by the responsible attending ICU physicians, who could stop the study agent infusion when the treatment failure or other conditions deemed necessary.
From the start of study agent infusion to postoperative day 1

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Time from the end of operation to randomization
Tidsramme: From the end of operation until the randomization, assessed up to 24 hours
Time from the end of operation to randomization
From the end of operation until the randomization, assessed up to 24 hours
Duration of study agent infusion
Tidsramme: From the start of study agent infusion to postoperative day 1
Duration of study agent infusion
From the start of study agent infusion to postoperative day 1
Incidence of adverse events from the start of study agent infusion until 24 hours or until ICU discharge
Tidsramme: From the start of study agent infusion to postoperative day 1
Include bradycardia (defined as heart rate lower than 55 beats/min), hypotension (defined as systolic blood pressure lower than 90 mmHg), and hypoxemia (defined as pulse oxygen saturation lower than 90%)
From the start of study agent infusion to postoperative day 1
Non-delirium complications
Tidsramme: From the start of study agent infusion to postoperative day 28
Include airway obstruction and apnea, respiratory failure, cardiac events, coma, epilepsy, cerebral hemorrhage or infarction, renal injury and infection
From the start of study agent infusion to postoperative day 28

Samarbejdspartnere og efterforskere

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

Efterforskere

  • Studiestol: Jian-Xin Zhou, MD, Capital Medical University

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

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 (Faktiske)

10. august 2020

Primær færdiggørelse (Faktiske)

12. december 2020

Studieafslutning (Faktiske)

21. december 2020

Datoer for studieregistrering

Først indsendt

28. juli 2020

Først indsendt, der opfyldte QC-kriterier

29. juli 2020

Først opslået (Faktiske)

31. juli 2020

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

12. januar 2021

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

10. januar 2021

Sidst verificeret

1. januar 2021

Mere information

Begreber relateret til denne undersøgelse

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Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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