Long-term Follow-up of Dexmedetomidine-esketamine and tDCS for Neurocognitive Complications After Surgery
Long-term Follow-up of Perioperative Dexmedetomidine-esketamine Combination and Transcranial Direct Current Stimulation for Prevention of Neurocognitive Complications in Older Patients After Non-cardiac Surgery
연구 개요
상태
상세 설명
Neurocognitive complications, mainly delirium and neurocognitive disorders, are common cerebral complications in older patients after surgery. Occurrence of neurocognitive complications is associated with prolonge hospital stay and increased in-hospital death. Furthermore, occurrence of neurocognitive complications is associated with adverse long-term outcomes, including cognitive decline, poor quality of life, and reduced long-term survival.
Dexmedetomidine is a highly selective alpha 2 adrenergic receptor agonist with sedative, analgesic, and anxiolytic effects. Available evidence showed that perioperative dexmedetomidine decreased early postoperative neurocognitive complications in older patients, possibly by improving analgesia and sleep quality and relieving surgery-related inflammation. However, routine dose dexmedetomidine increases bradycardia and hypotension which are potentially harmful to older patients.
Ketamine is a noncompetitive N-Methyl-D-aspartic acid (NMDA) receptor antagonist and has been used as an anesthetic and analgesic for decades. Esketamine is the S-enantiomer of ketamine and twice as potent as racemic ketamine. Recent studies found that subanesthetic dose of esketamine is effective in improving analgesia and sleep quality and relieving surgery-related stress response. However, even subanesthetic ketamine or esketamine increases neuropsychiatric side effects.
In clinical practice, dexmedetomidine-esketamine combination has been used for premedication in children and postoperative analgesia in adults and showed additive or synergistic effects. An ongoing trial conducted by the investigators plan to test the hypothesis that perioperative use of dexmedetomidine-esketamine combination may prevent postoperative neurocognitive complications in older patients. It is reasonable to hypothesize that perioperative dexmedetomdine-esketamine might also have favorable effects on long-term outcomes.
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique and increasingly used for treatment of various neurological diseases. Studies in the perioperative settings showed that perioperative use of tDCS improved sleep quality and reduced delirium occurrence early after surgery. The ongoing trial coducted by the investigators plan to test the hypothesis that perioperative use of tDCS may reduce postoperative neurocognitive complications in older patients. Perioperative tDCS might also have favorable effects on long-term outcomes.
This long-term follow-up of the ongoing 2×2 factorial trial aims to investigate the effects of perioperative dexmedetomidine-esketamine combination and tDCS on long-term outcomes in older patients after noncardiac surgery.
연구 유형
등록 (추정된)
단계
- 4단계
연락처 및 위치
연구 연락처
- 이름: Dong-Xin Wang, MD, PHD
- 전화번호: 86 10 83572784
- 이메일: wangdongxin@hotmail.com
연구 연락처 백업
- 이름: Zhen-Zhen Xu, MD
- 전화번호: 86 10 83572460
- 이메일: zjxvzhenzhen@126.com
연구 장소
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Beijing Municipality
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Beijing, Beijing Municipality, 중국, 100034
- Peking University First Hospital
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연락하다:
- Zhen-Zhen Xu, MD
- 전화번호: 86 10 83572460
- 이메일: zjxvzhenzhen@126.com
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연락하다:
- Dong-Xin Wang, MD, PhD
- 전화번호: +86 10 83572784
- 이메일: wangdongxin@hotmail.com
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Fujian
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Fuzhou, Fujian, 중국, 362011
- Fujian Medical University Union Hospital
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연락하다:
- Dan-Feng Zhang, MD
- 이메일: mazui1234@163.com
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Guangdong
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Shenzhen, Guangdong, 중국, 518036
- Peking University Shenzhen Hospital
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연락하다:
- Tao Luo, MD
- 이메일: 496855048@qq.com
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Shaanxi
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Xi'an, Shaanxi, 중국, 710032
- Xijing Hospital, Air Force Medical University
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연락하다:
- Zhi-Hong Lu, MD
- 이메일: deerlu23@163.com
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Zhejiang
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Hangzhou, Zhejiang, 중국, 310006
- First Affilited Hospital, School of Medicine, Zhejiang University
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연락하다:
- Dian-San Su, MD
- 이메일: diansansu@yahoo.com
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Hangzhou, Zhejiang, 중국, 310009
- Second Affilited Hospital, School of Medicine, Zhejiang University
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연락하다:
- Min Yan, MD
- 이메일: zryanmin@zju.edu.cn
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참여기준
자격 기준
공부할 수 있는 나이
- 고령자
건강한 자원 봉사자를 받아들입니다
설명
Inclusion Criteria:
- Aged 65 to 90 years;
- Preoperative Mini-Mental State Examination (MMSE) score < 27 points, indicating possible cognitive impairment ranging from mild to moderate;
- Scheduled to undergo elective non-cardiac, non-neurosurgical surgery under general anesthesia, with an expected surgical duration > 1 hour;
- Required patient-controlled intravenous analgesia (PCIA) after surgery.
Exclusion Criteria:
- Preoperative inability to communicate due to coma, severe dementia, endstage disease, or language impairment;
- History of schizophrenia, epilepsy, Parkinson's disease, brain trauma/surgery, or myasthenia gravis;
- Presence of metal implants in the intracranial or cervical region (such as cochlear implants, aneurysm clips, deep brain stimulation electrodes), or skin damage or severe skin disease on the head;
- Severe cardiac dysfunction (left ventricular ejection fraction < 30%), comorbid with sick sinus syndrome, severe bradycardia (heart rate < 50 bpm), or second-degree or higher atrioventricular block, or implantation of a cardiac pacemaker;
- Uncontrolled hyperthyroidism or pheochromocytoma;
- Severe liver dysfunction (Child-Pugh class C), severe renal dysfunction (requiring dialysis), or ASA classification ≥ IV;
- Allergy to dexmedetomidine or esketamine;
- Participation in other clinical studies within the past 3 months;
- Other conditions that are deemed unsuitable for study participation.
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 방지
- 할당: 무작위
- 중재 모델: 요인 할당
- 마스킹: 네 배로
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
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실험적: Dex-Esk + active tDCS
Participants will receive dexmedetomidine-esketamine (Dex-Esk) combination and active transcranial direct current stimulation (tDCS).
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Dexmedetomidine-esketamine combination (1 μg/mL dexmedetomidine and 0.5 mg/mL esketamine) will be administered after anesthesia induction, firstly as a loading dose at a rate of [0.4 x body weight (kg)] mL/h for 30 minutes (0.2 μg/kg dexmedetomidine and 0.1 mg/kg esketamine), followed by a maintenance infusion at a rate of [0.1 x body weight (kg)] mL/h (0.1 μg/kg/h dexmedetomidine and 0.05 mg/kg/h esketamine) until one hour before expected end surgery. Postoperative patient-controlled analgesia will be established with a 100 mL mixture (containing 1.0 μg/mL sufentanil, 1.25 μg/mL dexmedetomidine, and 0.25 mg/mL esketamine in normal saline), programmed to deliver 2-mL boluses with an 8-minute lockout interval and an 1-mL/h background infusion, and provided for 48 hours (at least 24 hours).
다른 이름들:
Active transcranial direct current stimulation (tDCS) will be administered using a battery-powered stimulator. The anode will be positioned over the left dorsolateral prefrontal cortex (DLPFC, F3) and the cathode over the right supraorbital region (Fp2). The stimulation intensity will be set at 2.0 mA, featuring a 30-second linear ramp-up at the beginning and a 30-second ramp-down at the end of each session. Each participant will receive a total of three 20-minute sessions of active tDCS. The first session will be provided at 40 minutes after extubation in the post-anesthesia care unit. Two other sessions will be provided on postoperative days 1 and 2 (between 10:00 and 12:00 am).
다른 이름들:
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실험적: Dex-Esk + sham tDCS
Participants will receive dexmedetomidine-esketamine (Dex-Esk) combination and sham (placebo) transcranial direct current stimulation (tDCS).
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Dexmedetomidine-esketamine combination (1 μg/mL dexmedetomidine and 0.5 mg/mL esketamine) will be administered after anesthesia induction, firstly as a loading dose at a rate of [0.4 x body weight (kg)] mL/h for 30 minutes (0.2 μg/kg dexmedetomidine and 0.1 mg/kg esketamine), followed by a maintenance infusion at a rate of [0.1 x body weight (kg)] mL/h (0.1 μg/kg/h dexmedetomidine and 0.05 mg/kg/h esketamine) until one hour before expected end surgery. Postoperative patient-controlled analgesia will be established with a 100 mL mixture (containing 1.0 μg/mL sufentanil, 1.25 μg/mL dexmedetomidine, and 0.25 mg/mL esketamine in normal saline), programmed to deliver 2-mL boluses with an 8-minute lockout interval and an 1-mL/h background infusion, and provided for 48 hours (at least 24 hours).
다른 이름들:
Sham transcranial direct current stimulation (tDCS) will be administered using a battery-powered stimulator. The anode will be positioned over the left dorsolateral prefrontal cortex (DLPFC, F3) and the cathode over the right supraorbital region (Fp2). To ensure blinding, the device will deliver a initial 30-second ramp-up to 2.0 mA followed immediately by a 30-second ramp-down to 0 mA. The device remains "ON" for the remaining 19 minutes with no effective current output, mimicking the peripheral scalp sensation without delivering cortical modulation. Each participant will receive a total of three 20-minute sessions of sham tDCS. The first session will be provided at 40 minutes after extubation in the post-anesthesia care unit. Two other sessions will be provided on postoperative days 1 and 2 (between 10:00 and 12:00 am).
다른 이름들:
|
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실험적: Placebo + active tDCS
Participants will receive placebo (normal saline) and active transcranial direct current stimulation (tDCS).
|
Active transcranial direct current stimulation (tDCS) will be administered using a battery-powered stimulator. The anode will be positioned over the left dorsolateral prefrontal cortex (DLPFC, F3) and the cathode over the right supraorbital region (Fp2). The stimulation intensity will be set at 2.0 mA, featuring a 30-second linear ramp-up at the beginning and a 30-second ramp-down at the end of each session. Each participant will receive a total of three 20-minute sessions of active tDCS. The first session will be provided at 40 minutes after extubation in the post-anesthesia care unit. Two other sessions will be provided on postoperative days 1 and 2 (between 10:00 and 12:00 am).
다른 이름들:
Placebo (normal saline) will be administered after anesthesia induction, firstly as a loading dose at a rate of [0.4 x body weight (kg)] mL/h for 30 minutes, followed by a maintenance infusion at a rate of [0.1 x body weight (kg)] mL/h until one hour before expected end surgery. Postoperative patient-controlled analgesia will be established with a 100 mL mixture (containing 1.0 μg/mL sufentanil in normal saline), programmed to deliver 2-mL boluses with an 8-minute lockout interval and an 1-mL/h background infusion, and provided for 48 hours (at least 24 hours).
다른 이름들:
|
|
위약 비교기: Placebo + sham tDCS
Participants will receive placebo (normal saline) and sham (placebo) transcranial direct current stimulation (tDCS).
|
Sham transcranial direct current stimulation (tDCS) will be administered using a battery-powered stimulator. The anode will be positioned over the left dorsolateral prefrontal cortex (DLPFC, F3) and the cathode over the right supraorbital region (Fp2). To ensure blinding, the device will deliver a initial 30-second ramp-up to 2.0 mA followed immediately by a 30-second ramp-down to 0 mA. The device remains "ON" for the remaining 19 minutes with no effective current output, mimicking the peripheral scalp sensation without delivering cortical modulation. Each participant will receive a total of three 20-minute sessions of sham tDCS. The first session will be provided at 40 minutes after extubation in the post-anesthesia care unit. Two other sessions will be provided on postoperative days 1 and 2 (between 10:00 and 12:00 am).
다른 이름들:
Placebo (normal saline) will be administered after anesthesia induction, firstly as a loading dose at a rate of [0.4 x body weight (kg)] mL/h for 30 minutes, followed by a maintenance infusion at a rate of [0.1 x body weight (kg)] mL/h until one hour before expected end surgery. Postoperative patient-controlled analgesia will be established with a 100 mL mixture (containing 1.0 μg/mL sufentanil in normal saline), programmed to deliver 2-mL boluses with an 8-minute lockout interval and an 1-mL/h background infusion, and provided for 48 hours (at least 24 hours).
다른 이름들:
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Incidence of postoperative neurocognitive disorders (pNCD) at 3 months
기간: At 3 months after surgery
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Cognitive function will be assessed at baseline and at 3 months after surgery using the Telephone version of Montreal Cognitive Assessment (T-MoCA; scores range from 0 to 22, with higher scores indicating better cognitive function）. Postoperative neurocognitive disorders (pNCD) is defined as: a |Z| value of decline in T-MoCA score ≥1.96. Z value = [(change from baseline in T-MoCA score in a surgical patient - mean change from baseline in T-MoCA scores in the non-surgical group)] / (standard deviation of change from baseline in T-MoCA scores in the non-surgical group). |
At 3 months after surgery
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Event-free survival
기간: Up to 1 year after surgery of the last enrolled patient
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Time interval from index surgery to cancer recurrence/metastasis/progression, new-onset cancer, new-onset serious illness (requiring hospitalization), or all-cause death, whichever comes first.
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Up to 1 year after surgery of the last enrolled patient
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기타 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Overall survival
기간: Up to 1 year after surgery of the last enrolled patient
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Time interval from index surgery to all-cause death.
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Up to 1 year after surgery of the last enrolled patient
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Recurrence-free survival
기간: Up to 1 year after surgery of the last enrolled patient
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Time interval from index surgery to cancer recurrence/metastasis/progression or all-cause death, whichever comes first.
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Up to 1 year after surgery of the last enrolled patient
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Activities of daily living score
기간: At 3 months, 6 months, and 1 year after surgery
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Daily living activities will be assessed with the activities of daily living (ADL; scores range from 1 to 56, with higher scores indicating worse ability of daily living).
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At 3 months, 6 months, and 1 year after surgery
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Incidence of postoperative neurocognitive disorders (pNCD) at 6 months and 1 year
기간: At 6 months and 1 year after surgery
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Cognitive function will be assessed at baseline and at 6 months and 1 year after surgery using the Telephone version of Montreal Cognitive Assessment (T-MoCA; scores range from 0 to 22, with higher scores indicating better cognitive function）. Postoperative neurocognitive disorders (pNCD) is defined as: a |Z| value of decline in T-MoCA score ≥1.96. Z value = [(change from baseline in T-MoCA score in a surgical patient - mean change from baseline in T-MoCA scores in the non-surgical group)] / (standard deviation of change from baseline in T-MoCA scores in the non-surgical group). |
At 6 months and 1 year after surgery
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공동 작업자 및 조사자
협력자
수사관
- 수석 연구원: Dong-Xin Wang, MD, PhD, Peking University First Hospital
간행물 및 유용한 링크
일반 간행물
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수술에 대한 임상 시험
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Sinai UniversityMenoufia University완전한
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