Anesthetic Neurotoxicity: the Association Between General Anesthesia and the Level of Plasma Neurofilament Light

Anesthetic Neurotoxicity: the Association Between General Anesthesia and the Level of Plasma Neurofilament Light

Patrocinadores

Patrocinador principal: Cardiocentro Ticino

Fuente Cardiocentro Ticino
Resumen breve

A prospective controlled single centre study designed to determine the association between the exposure to anesthetic agents and the pre and postoperative changes in plasma Neurofilament Light levels, biomarkers of neurological injury, in patients with similar surgical intervention but different anesthetic techniques.

Secondary endpoints: Association between the changes in plasma Neurofilament Light levels and the development of post-operative neurocognitive disorders as acute delirium.

Descripción detallada

Our intent is to evaluate the impact of the general anesthesia on the Central Nervous System, trying to minimize the surgical bias as much as possible. For this purpose, it is necessary to consider two groups of patients who undergo to similar surgical intervention, but with exposed to different anesthetic techniques. In particular, one group with local anesthesia and one group with general anesthesia.

The population sample will be composed of all patients who satisfy the inclusion and exclusion criteria and scheduled for the implantation of pacemaker (PM) - a procedure that require a local anesthesia - and the implantation of a cardioverter defibrillator (ICD), a cardiac resynchronization therapy pacemaker (CRT-P) and a cardiac resynchronization therapy defibrillator (CRT-D) at the Cardiocentro Ticino Lugano, procedures usually realize under general anesthesia.

The population sample will be divided in two groups: the non-exposed group, or control group, will be composed by the patients undergo PM implantation (without anesthesia) and the exposed group will be composed by the patients that undergo CRT/ICD implantation (general anesthesia).

Inclusion criteria:

- Same type of surgery: ICD,CRT-P, CRT-D and PM implantation;

- Age > 18 years old

- Patients who have expressed their consent to the participation of the study

Exclusion criteria:

- Patients with history of neurodegenerative diseases and neurocognitive disorders: the presence of these disorders could influence the level of the neuro-markers.

No change will be applied to normal clinical practice: we'll collect two blood samples, taken from routine samples already performed in our clinical practice, for the dosage of Neurofilament Light plasma levels before (t0) and after the procedure (t+24h).

Our intent is to compare the NF-L plasma levels delta (pre or t0 - postoperative or t24) between the exposed group (general anesthesia) and the not exposed group (local anesthesia).

Blood samples will be collected and stored in EDTA at the times specified above and anonymized. The samples, post anonymization, will be send to the University Hospital of Basel (Basel, Switzerland) where the plasma concentration of neurodegeneration markers will be blindly measured using the SiMoA neurology 4-plex assay.

The neurological status of the patients will be monitored daily during the first 2 days of the post-operative course in intensive care or in the ward. The screening of the phenomenon will be carried out by the nursing staff through the CAM-ICU and CAM (screening), in accordance with the internal protocols. The screening will be performed and documented at least three times a day or when the need is detected by the nursing staff. Any diagnosis of delirium will be certified by the neurologist.

Exams or procedures that differ from normal clinical practice will not be performed, except for the dosage of Neurofilament Light.

Estado general Recruiting
Fecha de inicio November 11, 2019
Fecha de Terminación October 31, 2020
Fecha de finalización primaria October 31, 2020
Tipo de estudio Observational [Patient Registry]
Resultado primario
Medida Periodo de tiempo
Changes in plasma Neurofilament Light levels 24 hours
Resultado secundario
Medida Periodo de tiempo
Changes in plasma Neurofilament Light levels and acute postoperative neurocognitive disorders 48 hours
Inscripción 120
Condición
Intervención

Tipo de intervención: Drug

Nombre de intervención: General anesthetic

Descripción: General anesthesia (propofol, fentanyl, sevorane, remifentanyl, rocuronium)

Etiqueta de grupo de brazo: Exposed group

Elegibilidad

Método de muestreo: Non-Probability Sample

Criterios:

Inclusion Criteria:

- Same type of surgery: ICD,CRT-P, CRT-D and PM implantation;

- Age > 18 years old

- Patients who have expressed their consent to the participation of the study

Exclusion Criteria:

- Patients with history of neurodegenerative diseases and neurocognitive disorders: the presence of these disorders could influence the level of the neuro-markers.

Género: All

Edad mínima: 18 Years

Edad máxima: N/A

Voluntarios Saludables: Accepts Healthy Volunteers

Oficial general
Contacto general

Apellido: Stefania SB Buson, Dr.

Teléfono: +41 91 805 31 85

Email: [email protected]

Ubicación
Instalaciones: Estado: Contacto: Investigador: Cardiocentro Ticino Tiziano TC Cassina, MD +41 (0)91 8053183 [email protected] Stefania SB Buson, DR Sub-Investigator Michele MV Villa, RN Sub-Investigator
Ubicacion Paises

Switzerland

Fecha de verificación

November 2019

Fiesta responsable

Tipo: Principal Investigator

Afiliación del investigador: Cardiocentro Ticino

Nombre completo del investigador: Tiziano Cassina

Título del investigador: Professor med. Tiziano Cassina

Palabras clave
Tiene acceso ampliado No
Condición Examinar
Grupo de brazo

Etiqueta: Exposed group

Descripción: The exposed group will be composed by the patients that undergo CRT/ICD implantation (general anesthesia).

Etiqueta: Not exposed group

Descripción: The non-exposed group, or control group, will be composed by the patients undergo PM implantation (without anesthesia)

Acrónimo ANESTOX-2019
Datos del paciente No
Información de diseño del estudio

Modelo de observación: Cohort

Perspectiva de tiempo: Prospective

Fuente: ClinicalTrials.gov