Anaesthetic Depth and Short Term Delirium Post Cardiac Surgery Intervention

NCT ID: NCT05877326

Last Updated: 2023-06-13

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 200 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-09-30
• Study Completion Date: 2025-05-10

Brief Summary

Postoperative delirium (POD) is a critical complication of major surgery and affects up to 70% of surgical patients over the age of 60 years.

The additional healthcare costs associated with delirium exceed €50,000 per patient per year due to prolonged hospital stay, increased risk of long-term care or institutionalization, and the risk of developing dementia or cognitive impairment . Therefore, prevention of POD is a major goal in the perioperative setting.

The investigator proposes this randomized study to evaluate the interest of a reduced anesthetic depth to prevent short-term cognitive disorders after cardiac surgery in elderly subjects.

Method: Patients over 75 years old scheduled to undergo one of the cardiac surgeries of interest (valvular, coronary bypass, aortic or combined surgery) will be randomized to 2 paralell arms :

• Perioperative anesthesia with a BIS (Bispectral index) target of 35
• Perioperative anesthesia with a BIS(Bispectral index) target of 55

The presence of mental confusion will be determined by CAM-ICU ( Confusion Assessment Method for the ICU ) at day 3 post procedure.

Ancillary study: To assess cognitive status at inclusion, discharge and third post operative month using the MOCA(Montreal Cognitive Assessment ).

Conclusion:The hypothesis of this study is that a lower depth of anesthesia will reduce post operative delirium in the first three days in patients older than 75 years who are planned for valvular, coronary artery bypass, aortic or combined cardiac surgery .

Detailed Description

Multicenter, controlled, randomized trial with two parallel arms (Perioperative anesthesia with a BIS target of 35 / Perioperative anesthesia with a BIS target of 55).

Randomization will be stratified by center, type of surgery (valve vs coronary artery bypass surgery vs aortic surgery vs combined surgery), patient age (75-80 vs 81-85), Euroscore 2 score at inclusion (predicted mortality risk ≥ vs < to 30%).

An ancillary study with MOCA score measurement at inclusion, discharge and 3 months after cardiac surgery will be realized.

Primary Objective:

To demonstrate the benefit of lower anesthesia on the prevalence of delirium during the first 3 days postoperatively in patients aged 75 years and older having cardiac surgery (valvular, coronary bypass, aortic or combined surgery).

Primary endpoint:

Presence of mental confusion will be determined by CAM-ICU at day 3 post surgery.

The CAM-ICU is considered POSITIVE (confusion present) if criteria 1 and 2 + 3 or 4 are met.

Secondary objectives:

To evaluate the effects of the intervention on ICU and hospital length of stay, delirium durations, mortality at month 3 , prevalence of POD during the stay, duration of mechanical ventilation, rate of reintubation,total amount of propofol, opioids and neuromuscular blockade (au lieu de curares) during anesthesia .

Secondary endpoints:

CAM ICU at times day 1, Day 2 , and Day 3 , daily doses of benzodiazepines, opiates, propofol, dexmedetomidine, and neuroleptics, days without mechanical ventilation, ICU and total lengths of stay, vital status (phone call) at Month 3, duration of delirium, total amount of propofol, opioids and neuromuscular blockade during anesthesia .

In order to demonstrate a minimum difference in the confounding rate (according to CAM-ICU) of 20 points (50% expected in the BIS 35 arm versus 30% in the BIS 55 arm) and with a two-sided first-species risk of 5% and a minimum power of 80%, 186 analyzable subjects (93 per arm) are required.

In order to take into account possible loss of sight, we propose to include in this study a total of 200 subjects (100 per arm).

Conditions

Post-operative Delirium; Anaesthetic Depth

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Perioperative anesthesia with a BIS target of 35

Anesthesia with a BIS target of 35

Group Type: ACTIVE_COMPARATOR

General anesthesia with propofol or sevoflurane

Intervention Type: DRUG

General anesthesia

CAM-ICU (Confusion Assesment Method ICU) at day 3 post-operative

Intervention Type: BEHAVIORAL

The presence of mental confusion will be determined by CAM-ICU at J3 post intervention.

Perioperative anesthesia with a BIS target of 55

Anesthesia with a BIS target of 55

Group Type: ACTIVE_COMPARATOR

General anesthesia with propofol or sevoflurane

Intervention Type: DRUG

General anesthesia

CAM-ICU (Confusion Assesment Method ICU) at day 3 post-operative

Intervention Type: BEHAVIORAL

The presence of mental confusion will be determined by CAM-ICU at J3 post intervention.

Interventions

General anesthesia with propofol or sevoflurane

General anesthesia

Intervention Type: DRUG

CAM-ICU (Confusion Assesment Method ICU) at day 3 post-operative

The presence of mental confusion will be determined by CAM-ICU at J3 post intervention.

Intervention Type: BEHAVIORAL

Other Intervention Names

General anesthesia with 35 BIS target or 55 BIS target

Eligibility Criteria

Inclusion Criteria

• Patient aged between 75 and 85 years, who signed an informed consent, undergoing elective valvular, coronary artery bypass, aortic or combined cardiac surgery
• Be affiliated to French Health Insurance

Exclusion Criteria

• Refusal of consent -Patient unable to read, write or understand French
• Vulnerable patient according to article L1121-6 of the CSP,
• Patient of legal age under guardianship or curatorship or under legal protection,
• Patient unable to give personal consent according to article L.1121-8 of the CSP or adult protected by law,
• Patient having already participated in the present study

• Minimum Eligible Age: 75 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Centre Cardiologique du Nord

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Ellouze Omar, MD

Role: PRINCIPAL_INVESTIGATOR

Centre Cardiologique du Nord

Locations

Centre cardiologique du nord

Saint-Denis, , France

Countries

France

Central Contacts

Ellouze Omar, MD

Role: CONTACT

ellouze.omar@yahoo.fr

0149337245

Moussouni karima, CRA

Role: CONTACT

K.MOUSSOUNI@CCN.FR

0679145144

References

Ellouze O, Zogheib E, Abdelhafidh K, Lemaire A, Berger J, Charfeddine A, Bouzguenda H, Konstantinou M, Molinari N, Bonnet N, Geri G, Nappi F. Anaesthetic depth and short-term delirium after cardiac surgery intervention: the study protocol of the BISCAR multicentre randomised clinical trial. BMJ Open. 2025 Aug 28;15(8):e103105. doi: 10.1136/bmjopen-2025-103105.

Reference Type: DERIVED

PMID: 40876878 (View on PubMed)

Other Identifiers

2022-A02200-43

Identifier Type: -

Identifier Source: org_study_id