Anesthetic Depth and Postoperative Delirium Trial - 2

NCT ID: NCT01983384

Last Updated: 2019-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

205 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-07-31

Study Completion Date

2017-10-31

Brief Summary

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Recent limited evidence suggests that anesthetic depth may influence postoperative cognitive outcomes, however, the mechanism between this association is unclear.

Detailed Description

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Recently, it has been proposed that use of a processed electroencephalogram (EEG) monitor during surgery may be associated with a lower rate of postoperative delirium. In fact, some suggest that older patients undergoing surgery should routinely be monitored with an anesthetic depth monitor to allow the titration of anesthetics or sedation medications to lighter levels to promote better postoperative cognitive outcomes. Recent studies, including preliminary results from our group, have demonstrated electroencephalogram (EEG) suppression to be an independent risk factor for postoperative delirium.

Prior studies that have focused on risk prediction have shown age and prior cognitive impairment to be the most consistent risk factors for postoperative delirium. However, as of yet, no clinical trial has identified a relationship whether use of processed EEG monitor resulted in a reduction of incident postoperative delirium through a reduction in EEG suppression, with proper consideration of patients' baseline cognitive status as a potential moderator. Additionally, use of anesthetic depth monitor to keep patients' anesthetic depth above a specified value has never been validated or proven to be feasible or safe.

Accordingly, the investigators plan an exploratory study to: 1) determine whether the use of processed EEG to keep anesthetic depth above a specified level, results in a reduction in EEG suppression when compared to standard anesthetic care, 2) to determine whether preoperative level of cognitive function moderates the effect of group assignment on EEG suppression, and 3) to determine the feasibility and safety of using processed EEG-guided to keep patients' anesthetic depth above a specified value. A secondary aim was to determine the effect size for the intervention to reduce postoperative delirium for subjects with and without preoperative cognitive impairment for a future trial.

Conditions

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Delirium Cognitive Disorders

Keywords

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Delirium Cognition Surgery Anesthesia Aging Electroencephalography

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be assigned to receive processed EEG-guided anesthesia or standard anesthetic care. Patients in both groups will be monitored with processed EEG, however those in the standard care group will have the anesthesiologist blinded to the machine. Patients in the interventional group receive processed EEG-guided anesthetic maintenance.
Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Patients are assigned to study arm by random number generator. Anesthesiologists are informed which study arm the patient is assigned before the day of surgery. Patients are not informed of study arm assignment. Research staff assessing for postoperative delirium are not informed of patient study arm assignment.

Study Groups

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Anesthetic Depth: standard care

A cohort of older patients undergoing major non-cardiac surgery will be randomized to receive routine anesthetic management not guided by the processed electroencephalogram

Group Type PLACEBO_COMPARATOR

Processed EEG-guided anesthetic depth

Intervention Type OTHER

Investigators will undertake a randomized control trial in a cohort of older patients undergoing major non-cardiac surgery to receive either a control vs. an intervention of anesthesia as determined by a processed electroencephalogram

Anesthetic Depth: interventional

A cohort of older patients undergoing major non-cardiac surgery will be randomized to receive anesthetic management guided by the processed electroencephalogram (processed EEG-guided anesthetic depth)

Group Type EXPERIMENTAL

Processed EEG-guided anesthetic depth

Intervention Type OTHER

Investigators will undertake a randomized control trial in a cohort of older patients undergoing major non-cardiac surgery to receive either a control vs. an intervention of anesthesia as determined by a processed electroencephalogram

Interventions

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Processed EEG-guided anesthetic depth

Investigators will undertake a randomized control trial in a cohort of older patients undergoing major non-cardiac surgery to receive either a control vs. an intervention of anesthesia as determined by a processed electroencephalogram

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* 65 years and older of age undergoing non-cardiac surgery, requiring hospital stay of 2 or more days.

Exclusion Criteria

* patients who are not fluent in English or cannot provide informed consent
* patients who may not tolerate either light or deep anesthesia (history of heart failure, coronary artery disease, substance abuse)
* history of intraoperative recall or awareness during anesthesia
* pathologies of the brain which may affect EEG monitoring
* patients who are anticipated to have consecutive surgery within 3 days of first procedure
* patients who have had surgery with general anesthesia in the past 30 days
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Virginia Polytechnic Institute and State University

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jacqueline Leung, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of California, San Francisco

Locations

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University of California, San Francisco Medical Center

San Francisco, California, United States

Site Status

Countries

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United States

References

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Tang CJ, Jin Z, Sands LP, Pleasants D, Tabatabai S, Hong Y, Leung JM. ADAPT-2: A Randomized Clinical Trial to Reduce Intraoperative EEG Suppression in Older Surgical Patients Undergoing Major Noncardiac Surgery. Anesth Analg. 2020 Oct;131(4):1228-1236. doi: 10.1213/ANE.0000000000004713.

Reference Type DERIVED
PMID: 32925344 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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ANESDEPTH

Identifier Type: -

Identifier Source: org_study_id