General Anesthesia, Geriatric Patient
Conditions
Keywords
Postoperative delirium, Geriatric, General anesthesia, Propofol, Sevoflurane
Brief summary
Delirium is defined as an acute onset and fluctuating course of mental status change with inattention and an altered level of consciousness. Delirium in the postoperative period can be divided into emergence delirium and postoperative delirium, based on the time of onset (Silverstein et al., 2007).Postanaesthesia delirium is a frequent and potentially serious problem affecting the safety of patients and medical personnel. Clinical studies demonstrated that postoperative delirium is associated with worse outcomes such as prolonged hospital stay, postdischarge institutionalization, and increased mortality (Ely et al., 2004a; Thomason et al., 2005; Robinson et al., 2009). Multiple factors may contribute to the development of postoperative delirium, including patient's medical condition, administration of anesthetics or analgesics and degree of operative stress (Yildizeli et al., 2005; Robinson & Eiseman, 2008; Deiner & Silverstein, 2009). Sevoflurane anesthesia have been reported to be associated with more emergence delirium in pediatric patients, when compared with propofol anesthesia. It is not clear if propofol anesthesia will benefit the geriatric patients on postoperative delirium, when compared with sevoflurane anesthesia. We hypothesize that propofol anesthesia will reduce the rate of postoperative delirium by 50% when compared with sevoflurane anesthesia.
Interventions
DRUGPropofol
Anesthesia maintenance with propofol+remifentanil guided by Narcotrend index monitoring.
DRUGSevoflurane
Anesthesia maintenance with sevoflurane+remifentanil guided by Narcrotrend index monitoring.
Sponsors
Huazhong University of Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists Physical Status classification (ASA\_PS) class I-III * Aged 60 years or above * Elective major surgery under general anesthesia
Exclusion criteria
* ASA\_PS\>=IV * Aged under 60 yr old * Body mass index (BMI) \>30 * Neurologic disease * Cardiac surgery and neurologic surgery * Anticonvulsant drugs * Chronic analgesics intake * Participating in the investigation of another study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative delirium | at 24 postoperative hours | Postoperative delirium was determined by Confusion Assessment Method (CAM) at 24 postoperative hours |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic parameters | 5min, 10min, 20min, 30min after induction, 5min, 10min, 20min, 30min after skin incision, 5min, 10min, 20min, 30min before incision closure | Hart frequency, systolic blood pressure, diastolic blood pressure |
| Incidence of postoperative nausea and vomiting | 24 postoperative hours | Incidence of postoperative nausea and vomiting |
| Length of postanesthesia care unit (PACU) stay | up to 2 hours after PACU admitting | Length of PACU stay (min) |
| Postoperative delirium | 2st, 3st, 7st postoperative days | Postoperative delirium was determined by CAM every day at 2st, 3st, 7st postoperative days |
| Postoperative Stroke | 1st, 2st, 3st, 7st postoperative days | Postoperative Stroke will be determined by National Institutes of Health Stroke Scale (NIHSS) |
| Quality of recovery determined by quality of recovery (QOR-40; maximum score 200) score | 1,2,3,7 postoperative days | Quality of recovery determined by QOR-40 |
Countries
China
Contacts
Primary ContactWei Mei, MD., PhD
Outcome results
None listed