Emergence Delirium, Anesthesia
Conditions
Brief summary
To explore the relationship between plasma orexin levels during the recovery period of elderly patients undergoing general anesthesia and the occurrence of emergence delirium, and to evaluate its sensitivity and specificity as an objective diagnostic indicator for emergence delirium
Interventions
OTHERNo Intervention: Observational Cohort
No Intervention: Observational Cohort
Sponsors
Ruijin Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age is greater than or equal to 60 years old 2. It is planned to undergo elective non-cardiac surgery under general anesthesia, with the expected operation duration being greater than or equal to 2 hours 3. ASA I-III
Exclusion criteria
1. There was a clear diagnosis of mental illness before the surgery (such as schizophrenia, severe depression, etc.) or the patient had been using antidepressants or anti-psychotic drugs for a long time. 2. Preoperative presence of sleep-wake disorder-related diseases (such as narcolepsy, untreated moderate to severe obstructive sleep apnea syndrome, etc.) or long-term use of orexin receptor antagonists or agonists 3. Preoperatively, there was severe liver dysfunction (Child-Pugh grade B or C), severe renal dysfunction (estimated glomerular filtration rate eGFR \< 30 ml/min/1.73㎡), and severe anemia (Hb \< 80 g/L) 4. Perform deep sedation for extubation, plan to transfer to the ICU, or experience severe complications during the recovery period (such as anaphylactic shock, laryngospasm, etc.) 5. There are cases where individuals have severe visual or hearing impairments, or are aphasic, and thus are unable to cooperate in completing the cognitive assessment. 6. Having a history of alcohol abuse or drug addiction 7. Emergency surgery, neurosurgery surgery 8. The researchers considered it inappropriate to include in this study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergece Delirium | During extubation and 20 minutes after extubation | The CAM-ICU scale is administered at extubation and 20 minutes post-extubation during the PACU stay. A positive finding at either time point is defined as emergence delirium. |
| Plasma Orexin | 30 minutes before anesthesia induction, after anesthesia induction but before surgical incision, 1 hour after surgical incision, at the time of discontinuation of volatile anesthetics, at extubation, and 20 minutes post-extubation | Peripheral venous blood samples (3 mL each) are collected at six time points: 30 minutes before anesthesia induction, after induction but before incision, 1 hour after incision, at volatile anesthetic discontinuation, at extubation, and 20 minutes post-extubation. Samples are placed in EDTA tubes, stored at 2-8°C, centrifuged at 3000 rpm for 15 minutes at 4°C, and the separated plasma is stored at -80°C. Plasma orexin-A levels are measured by ELISA by technicians blinded to group assignment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| EEG power in beta band | From PACU admission to 20 minutes post-extubation | EEG power in beta band is continuously recorded throughout the entire emergence period using the Pearlcare EEG monitor. |
| Postoperative Delirium | 5 days post- operation | Postoperative delirium is assessed twice daily (8:00-10:00 and 18:00-20:00) from postoperative day 1 through day 5 using the CAM/CAM-ICU scale. A positive finding on any assessment is defined as the occurrence of postoperative delirium. The severity of delirium is evaluated using the DRS-R-98. |
| EEG power in delta band | From PACU admission to 20 minutes post-extubation | EEG power in delta band is continuously recorded throughout the entire emergence period using the Pearlcare EEG monitor. |
| EEG power in theta band | From PACU admission to 20 minutes post-extubation | EEG power in theta band is continuously recorded throughout the entire emergence period using the Pearlcare EEG monitor. |
| EEG power in alpha band | From PACU admission to 20 minutes post-extubation | EEG power in alpha band is continuously recorded throughout the entire emergence period using the Pearlcare EEG monitor. |
Countries
China
Outcome results
None listed