Cerebral Hypoxia, Postoperative Delirium
Conditions
Keywords
Delirium, Hypoxic Brain Damage, Propofol, S100b protein, Sevoflurane
Brief summary
The aim of this study is to distinguish possible differences in frequency of delirium after Volatile Induction and Maintenance of Anesthesia and Total Intravenous Anesthesia in case of undeliberate cerebral desaturation during non-cardiac surgery.
Detailed description
The aim of the present study is to investigate whether in non-cardiac surgery the frequency of POD after intraoperative undeliberate cerebral saturation could be modulated by the choice of the anesthetic strategy (Volatile Induction and Maintenance of Anesthesia \[VIMA\] and Total Intravenous Anesthesia \[TIVA\]). Based on our previous data we hypothesized that incidence of POD would be lower with VIMA compared to TIVA.
Interventions
DRUGSevoflurane
Induction of anesthesia: fentanyl 2 µg kg-1 and a bolus inhalation of 8% sevoflurane in an 8 L.min-1 fresh gas flow. Anesthesia maintenance: 1 minimal alveolar concentration (MAC) sevoflurane at a low fresh gas flow of 0.6-0.8 L min-1 in a 60% air-oxygen mixture supplemented with boluses of fentanyl.
DRUGPropofol
Induction of anesthesia: propofol 2 mg kg-1 and fentanyl 4 µg kg-1. Maintenance of anesthesia: infusion of propofol 8 mg kg-1 h-1 and boluses of fentanyl 3 µg kg-1.
Sponsors
Negovsky Reanimatology Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* class III-IV by physical status classification system of American Society of Anesthesiologist (ASA) * history of arterial vascular disease (arterial hypertension, myocardial ischemia and/or cerebral vascular disease) * undergoing elective non-cardiac surgery (hemicolectomy, hernioplasty, laparoscopic cholecystectomy and laparoscopic hysterectomy)
Exclusion criteria
* dementia * stroke or myocardial infarction ≤ 6 months before surgery * oncological disease of T2-4N3M1 stage
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Non-invasive blood pressure (NIBP) | Continued the entire surgery |
| Regional Cerebral Oxygenation (rSO2) | Continued the entire surgery |
| Peripheral tissue oxygen saturation (SpO2) | Continued the entire surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Incidences of postoperative delirium (POD) | Baseline, 24h and 48h after surgery | Applying the Confusion Assessment Method for the ICU (CAM-ICU) |
| Plasma concentration of S100b protein | Baseline, 24h and 48h after surgery | S100b protein is the neuronal injury marker |
Countries
Russia
Contacts
Primary ContactValery V. Likhvantsev, MD, Prof.
Outcome results
None listed