The Effects of Anaesthesia on Cerebral Oxygenation and Cognitive Function in Carotid Endarterectomy

NCT ID: NCT02771418

Last Updated: 2016-09-22

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

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-02-28

Study Completion Date

2016-06-30

Brief Summary

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Volatile anesthetics interfere with cerebral blood flow and reperfusion-ischemia injury via the mechanism known as a preconditioning. A transient deterioration of local hemodynamics and oxygenation during carotid endarterectomy (CEE) might involve both hemispheres of brain and affect postoperative cognitive function. The goal of this study was to assess the effects of anesthetics on perioperative cerebral oxygenation and cognitive functions.

Detailed Description

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Background: A transient deterioration of cerebral hemodynamics and oxygenation during CEE might involve both hemispheres of the brain and affects postoperative cognition. Despite some benefits of regional blocks, the majority of procedures of carotid endarterectomy (CEE) are performed under general anaesthesia. Surprisingly, the studies comparing the effects of sevoflurane and propofol on postoperative mental state in CEE are scarce and controversial. While propofol possesses some anti-inflammatory properties, volatile anesthetics can interfere with cerebral blood flow and reperfusion-ischaemia injury via the mechanism of pre- and postconditioning. The goal of this study is to assess the effects of the anesthetics on the perioperative cerebral oxygenation and cognitive functions in CEE.

Methods: The study and informed consent are approved by the Ethical Committee of the Northern State Medical University. Forty patients (males only) who are to undergo elective CEE will be included into a prospective study and randomised to two groups receiving either total intravenous anaesthesia (TIVA group, propofol + fentanyl) or the volatile induction and maintenance of anaesthesia (VIMA group, n = 20, sevoflurane + fentanyl). All patients were operated using temporary carotid bypass. Invasive arterial pressure (AP), gas exchange, and cerebral tissue oxygen saturation (SctO2, ForeSight, CAsMed, USA) over frontal region for ipsilateral (SctO2IPSI) and contralateral (SctO2CONTR) hemispheres were registered during the surgery and up to 20 hrs of the postoperative period. The cognitive changes will be assessed at 12 hrs before as well as on Days 1 and 5 after CEE by blinded investigator using Montreal Cognitive Assessment score (MoCA).

Data will be presented as median (25-75th percentiles). Intergroup comparison will be provided with Mann-Whitney U-test and correlation analysis with Spearman's coefficient (rho). P value below 0.05 was regarded as statistically significant.

Conditions

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Endarterectomy Postoperative Cognitive Dysfunction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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TIVA with propofol

Induction and maintenance of general anesthesia using TIVA with propofol

Group Type SHAM_COMPARATOR

Propofol

Intervention Type DRUG

Intravenous induction and maintenance of general anesthesia with propofol is a routine practice for this intervention

Elective carotid endarterectomy

Intervention Type PROCEDURE

VIMA with sevoflurane

Induction and maintenance of general anesthesia using VIMA with sevoflurane

Group Type ACTIVE_COMPARATOR

Sevoflurane

Intervention Type DRUG

Volatile induction and maintenance of general anesthesia with sevoflurane is a generally acceptable clinical approach for this intervention

Elective carotid endarterectomy

Intervention Type PROCEDURE

Interventions

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Propofol

Intravenous induction and maintenance of general anesthesia with propofol is a routine practice for this intervention

Intervention Type DRUG

Sevoflurane

Volatile induction and maintenance of general anesthesia with sevoflurane is a generally acceptable clinical approach for this intervention

Intervention Type DRUG

Elective carotid endarterectomy

Intervention Type PROCEDURE

Other Intervention Names

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Tital intravenous anesthesia (TIVA) Volatile induction and maintenance of anesthesia (VIMA)

Eligibility Criteria

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Inclusion Criteria

* \> 18 years
* Male gender
* Informed consent
* Symptomatic carotid stenosis \> 75%

Exclusion Criteria

* Contralateral carotid occlusion
* Known allergy to the one of the compared medications
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Northern State Medical University

OTHER

Sponsor Role lead

Responsible Party

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Vsevolod V. Kuzkov

MD, PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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City hospital # 1 / Northern State Medical University,

Arkhangelsk, , Russia

Site Status

Countries

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Russia

Other Identifiers

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CEE-VIMA

Identifier Type: -

Identifier Source: org_study_id

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