Effects of Different Types of General Anesthesia on Postoperative Pupillary Reactivity

NCT ID: NCT04307238

Last Updated: 2025-07-04

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

RECRUITING

Clinical Phase

NA

Total Enrollment

108 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-03-09

Study Completion Date

2026-03-10

Brief Summary

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Objective: To compare the effects of volatile and intravenous anesthetics on pupillary function after general anesthesia using a portable infrared pupillometer.

Design: A monocentric, prospective, double blinded randomized study.

Patients: Patients who require elective Ear, Nose and Throat (ENT) surgery under general anesthesia.

Interventions: Patients undergoing elective ENT surgery will be assigned to intravenous versus inhalative anesthesia and pupillometric parameters monitored postoperative, using an infrared pupillometer.

Outcomes measures: Reported pupillometric parameters after intravenous and inhalative anesthesia.

The purpose of this study is to compare general anesthesia techniques (volatile, intravenous) on postoperative changes in pupillary reactivity by using infrared pupillometry.

Detailed Description

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Introduction: With the increased focus on early discharge after surgery and anesthesia, it is important to identify objective criteria that can be used to assess home-readiness after ambulatory surgery. Premature discharge may lead to a higher rate of patients suffering complications and to an increased readmission rate. Time-consuming objective evaluations of postoperative vigilance status like EEG registrations are not practicable in routine postoperative clinical practice.

In this study an approach to a more quantitative judgment of postoperative vigilance and consciousness is made by recording pupillometric measurements using a portable infrared pupillometer. The findings of this study may provide new important insights to the meaning of pupillary responses for postoperative vigilance measurement.

Aim: With regard to the lack of knowledge about mechanisms that enable the central nervous system to restore consciousness after the deep functional disorder of the anesthetized state, this study aims to compare general anesthesia techniques (volatile, intravenous) on postoperative changes in pupillary reactivity by using infrared pupillometry.

The primary aim of this study is to investigate changes in pupillary reactivity (pupillary light reflex (PLR, %) in the early postoperative phase (2 hours) after common used types of general anesthesia techniques (inhaled - sevoflurane versus intravenous - propofol).

Secondary aim is to examine whether decreased postoperative PLR predicts a decline in neuropsychological testing (alertness).

Hypotheses: The investigators hypothesis that changes in PLR within the first 2 postoperative hours differs depending on the anesthesia technique used, with a lower decline in PLR after propofol compared to sevoflurane anesthesia.

Furthermore, the investigators hypothesis that postoperative PLR correlates with changes in alertness measured by a neuropsychological test.

Design: This study will be a prospective, randomized double blinded study.

Methods: The study is approved by the local ethics committee and written informed consent will be obtained from each patient. A total of 108 patients aged ≥18 and ≤99 years, with American Society of Anesthesiologist (ASA) physical status scores I-II, scheduled for elective ENT surgery will be enrolled. Baseline assessment of pupillometry and neuropsychological test will be carried out before surgery (baseline) and at predefined time intervals during the first 2 postoperative hours after the end of anesthesia. Results (AUC, PLR%) will be compared between both anesthesia groups.

Primary outcome parameter will be the AUC of PLR (percentage change, %) measured every 15 minutes during the first 2 postoperative hours. Secondary outcome parameter will include the neuropsychological test score (Digit Symbol Substitution Test (DSST), the Visual Intrinsic Alertness Test (VIA) and the Trail making Test (TMT)) will be performed every 30 minutes after general anesthesia (sevoflurane, propofol maintained).), assessed every 30 min up to 2 hours after discontinuation of anesthesia.

Conditions

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Pupillary Reflex Impaired

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

DOUBLE

Participants Investigators
double blinded study design (participants, evaluator)

Study Groups

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Propofol group

General anesthesia will be maintained by continually intravenous administered propofol.

Group Type OTHER

PLR

Intervention Type DIAGNOSTIC_TEST

PLR measurements will be performed within the first 2 postoperative hours.

Alertness testing

Intervention Type DIAGNOSTIC_TEST

Preoperative (baseline) and every 30 minutes postoperative computer based alertness testing will be performed.

Propofol anesthesia

Intervention Type PROCEDURE

Maintenance of anesthesia will be performed using propofol.

Sevoflurane Group

General anesthesia will be maintained by inhalative administered sevoflurane.

Group Type OTHER

PLR

Intervention Type DIAGNOSTIC_TEST

PLR measurements will be performed within the first 2 postoperative hours.

Alertness testing

Intervention Type DIAGNOSTIC_TEST

Preoperative (baseline) and every 30 minutes postoperative computer based alertness testing will be performed.

Sevoflurane anesthesia

Intervention Type PROCEDURE

Maintenance of anesthesia will be performed using sevoflurane.

Interventions

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PLR

PLR measurements will be performed within the first 2 postoperative hours.

Intervention Type DIAGNOSTIC_TEST

Alertness testing

Preoperative (baseline) and every 30 minutes postoperative computer based alertness testing will be performed.

Intervention Type DIAGNOSTIC_TEST

Propofol anesthesia

Maintenance of anesthesia will be performed using propofol.

Intervention Type PROCEDURE

Sevoflurane anesthesia

Maintenance of anesthesia will be performed using sevoflurane.

Intervention Type PROCEDURE

Other Intervention Names

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Pupillary light reflex DSST, VIA, TMT

Eligibility Criteria

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Inclusion Criteria

* Patients aged ≥ 18 and ≤99 years
* ASA I-II
* Patients undergoing elective ENT surgery under general anesthesia

Exclusion Criteria

* Patients aged \< 18 and \>99 years
* consumption of antidepressants, tranquilizer, psychotropic medications
* history of mental illness, neurosurgery, neurological or psychiatric disease
* ophthalmologic disease
* preexisting cognitive impairment
* Patients with drug dependence, alcoholism
* the patients' inability to follow procedures
* implanted electronic medical devices
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Vienna

OTHER

Sponsor Role lead

Responsible Party

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Marita Windpassinger M.D.

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Medical University Vienna

Vienna, Vienna, Austria

Site Status RECRUITING

Countries

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Austria

Central Contacts

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Marita Windpassinger, MD

Role: CONTACT

+43 1 40400 41020

Olga Plattner, Prof.MD

Role: CONTACT

+43 1 40400 41020

Facility Contacts

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Marita Windpassinger, MD

Role: primary

+43140400 ext. 41020

Olga Plattner, MD

Role: backup

+43140400 ext. 41020

Other Identifiers

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1520/2019

Identifier Type: -

Identifier Source: org_study_id

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