Monitoring Awareness and Pain Under Anesthesia Using a New EEG Based System
NCT ID: NCT02938325
Last Updated: 2023-12-08
Study Results
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Basic Information
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RECRUITING
90 participants
OBSERVATIONAL
2017-01-01
2024-12-31
Brief Summary
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The induction of GA includes combination of drugs - for sleep (inhalation anesthesia or hypnotic drugs intravenously), analgesia (opiates) and muscle relaxants. Since most of our patients paralyzed during surgery, the anesthesiologists have no way of knowing whether our paralyzed patient is asleep or awake. If the patient is awake and paralyzed, a situation named "awareness under anesthesia" it can cause him a traumatic experience that would leave him a cripple for his whole life.
There are many stories about patients who lay paralyzed, awake, while been operated, who remembered every word of what happened during the operation and of course could not mark the anesthetist that they are awake. The anesthesiologist might suspect that his patient is awake and paralyzed through "signals" from the sympathetic nervous system - for example the increase in heart rate and blood pressure. But many of our patients receive different medications (eg, beta-receptor blockers that does not allow the rise of a pulse) obscuring the clinical signs, so that the patient is awake and paralyzed without being noticed by the anesthesiologist.
Some patients are at a higher risk to suffer from awareness under anesthesia, because the anesthesiologist cannot provide "enough" anesthesia, due to their medical condition, for example: women in caesarean section under GA, patients in cardiac surgery or injured trauma patients.
Twenty years ago, an EEG based tool, naming "BIS" was developed. Nowadays, BIS monitor's credibility is questionable 1. The effect of different hypnotic drugs is not uniform. 2. Recently it was shown that a paralyzed patient BIS index could fall mimicking a situation of a sleep - enabling a paralyzed patient being awake. Thus, it is not clear whether the calculation of the BIS monitor is based on physiological models that define what is consciousness, loss of consciousness and how consciousness arises. It seems that the BIS is only suitable for certain drugs - not as a general monitor for the level of anesthesia.
The purpose of the present study is to develop a universal system for determining awareness under GA using an innovative algorithm for analyzing EEG waves, based on the physiological processes of attention and perception underlying the basis for sedation and GA.
Detailed Description
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Conditions
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Keywords
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Study Design
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CASE_CONTROL
PROSPECTIVE
Study Groups
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No intervention: General Anesthesia
Thirty patients undergoing elective surgery under general anesthesia who will be monitored with standard ASA, BIS and EEG for comparisons. In recovery unit, at the end of the surgery, patients will be questioned for awareness under anesthesia by Modified Brice Questionnaire.
There will be no intervention. Patients will be anesthetized with general anesthesia as they were supposed to be for their elective surgery. The EEG during the anesthesia will be assessed afterwards, and patients will be asked about their memory from the surgery.
No interventions assigned to this group
No intervention: Sedation
Fourty patients undergoing elective cardiac catheterization under conscious sedation who will be monitored with standard ASA, BIS and EEG for comparisons. In recovery unit, at the end of the procedure, patients will be questioned for awareness under sedation by Modified Brice Questionnaire.
There will be no intervention. Patients will be anesthetized with sedation as they were supposed to be for their elective cardiac catheterization. The EEG during the anesthesia will be assessed afterwards, and patients will be asked about their memory from the surgery.
No interventions assigned to this group
No Intervention - Awake Volunteers
EEG and BIS will be recorded in twenty volunteers, for 10 minutes, in supine position, while their eyes are closed. This recording will be utilized as for positive control for recall.
No interventions assigned to this group
Eligibility Criteria
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Inclusion Criteria
* Patients for elective surgery under general anesthesia or elective procedures under sedation (such as cardiac electrical studies, liver chemo-embiolization, biliary tract drainage)
* The willing of the patient to fulfil the Modified Brice Questionnaire at the end of the procedure in recovery unit
* Healthy volunteers that will accept to be monitored with EEG and BIS for 10 minutes in supine position, as control.
Exclusion Criteria
* Emergent surgery Emergent procedure (catheterization)
18 Years
ALL
Yes
Sponsors
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Rambam Health Care Campus
OTHER
Responsible Party
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Principal Investigators
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Dana Baron Shahaf, MD PhD
Role: PRINCIPAL_INVESTIGATOR
Rambam Health Care Campus
Locations
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Rambam Health Care Campus
Haifa, , Israel
Countries
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Central Contacts
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References
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White NS, Alkire MT. Impaired thalamocortical connectivity in humans during general-anesthetic-induced unconsciousness. Neuroimage. 2003 Jun;19(2 Pt 1):402-11. doi: 10.1016/s1053-8119(03)00103-4.
Alkire MT, Hudetz AG, Tononi G. Consciousness and anesthesia. Science. 2008 Nov 7;322(5903):876-80. doi: 10.1126/science.1149213.
Shalbaf R, Behnam H, Jelveh Moghadam H. Monitoring depth of anesthesia using combination of EEG measure and hemodynamic variables. Cogn Neurodyn. 2015 Feb;9(1):41-51. doi: 10.1007/s11571-014-9295-z. Epub 2014 May 9.
Osterman JE, Hopper J, Heran WJ, Keane TM, van der Kolk BA. Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry. 2001 Jul-Aug;23(4):198-204. doi: 10.1016/s0163-8343(01)00142-6.
Avidan MS, Palanca BJ, Glick D, Jacobsohn E, Villafranca A, O'Connor M, Mashour GA; BAG-RECALL Study Group. Protocol for the BAG-RECALL clinical trial: a prospective, multi-center, randomized, controlled trial to determine whether a bispectral index-guided protocol is superior to an anesthesia gas-guided protocol in reducing intraoperative awareness with explicit recall in high risk surgical patients. BMC Anesthesiol. 2009 Nov 30;9:8. doi: 10.1186/1471-2253-9-8.
Newton DE, Thornton C, Konieczko K, Frith CD, Dore CJ, Webster NR, Luff NP. Levels of consciousness in volunteers breathing sub-MAC concentrations of isoflurane. Br J Anaesth. 1990 Nov;65(5):609-15. doi: 10.1093/bja/65.5.609.
Dupont H. [Anesthesia awareness and the bispectral index]. Ann Fr Anesth Reanim. 2008 Dec;27(12):1042-3. doi: 10.1016/j.annfar.2008.10.013. No abstract available. French.
Short TG, Campbell D, Leslie K. Response of bispectral index to neuromuscular block in awake volunteers. Br J Anaesth. 2016 May;116(5):725-6. doi: 10.1093/bja/aew089. No abstract available.
Suzuki M, Edmonds HL Jr, Tsueda K, Malkani AL, Roberts CS. Effect of ketamine on bispectral index and levels of sedation. J Clin Monit Comput. 1998 Jul;14(5):373. doi: 10.1023/a:1009975701184. No abstract available.
Voss L, Sleigh J. Monitoring consciousness: the current status of EEG-based depth of anaesthesia monitors. Best Pract Res Clin Anaesthesiol. 2007 Sep;21(3):313-25. doi: 10.1016/j.bpa.2007.04.003.
Chen Y, Cai A, Dexter F, Pryor KO, Jacobsohn EM, Glick DB, Willingham MD, Escallier K, Winter A, Avidan MS. Amnesia of the Operating Room in the B-Unaware and BAG-RECALL Clinical Trials. Anesth Analg. 2016 Apr;122(4):1158-68. doi: 10.1213/ANE.0000000000001175.
Brunner M, Vaughan D. Evoked potential monitoring in anaesthesia and analgesia. Anaesthesia. 2000 Aug;55(8):823-5. doi: 10.1046/j.1365-2044.2000.01629-27.x. No abstract available.
Shahaf G, Pratt H. Thorough specification of the neurophysiologic processes underlying behavior and of their manifestation in EEG - demonstration with the go/no-go task. Front Hum Neurosci. 2013 Jun 24;7:305. doi: 10.3389/fnhum.2013.00305. eCollection 2013.
Shahaf G, Fisher T, Aharon-Peretz J, Pratt H. Comprehensive analysis suggests simple processes underlying EEG/ERP - demonstration with the go/no-go paradigm in ADHD. J Neurosci Methods. 2015 Jan 15;239:183-93. doi: 10.1016/j.jneumeth.2014.10.016. Epub 2014 Nov 1.
Other Identifiers
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152-16 rambam-CTIL
Identifier Type: -
Identifier Source: org_study_id