The Effects of Anesthesia Depth Monitoring on Postoperative Recovery and Cognitive Functions in the Geriatric Patient Population

NCT ID: NCT06844279

Last Updated: 2025-02-28

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

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-10

Study Completion Date

2025-04-30

Brief Summary

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This study will be conducted on patients aged 65 and older scheduled for surgery due to lumbar or cervical disc herniation. General anesthesia is routinely used for these types of surgeries in the hospital. In patients receiving general anesthesia, anesthesia depth monitoring is performed.

As part of the study, a preoperative anesthesia evaluation will be conducted, which will include age, weight, height, comorbidities, regularly used medications, previous surgical or anesthesia experiences, nutritional habits, mental status, and daily activity levels.

On the day of surgery, upon arrival in the operating room, the following will be measured and recorded:

* Blood pressure using a non-invasive blood pressure monitor
* Heart rate and rhythm via electrocardiogram (ECG)
* Blood oxygen level with a pulse oximeter
* Anesthesia depth using a forehead-applied sensor

All monitoring procedures are non-invasive and painless. Following the placement of these monitoring devices and initial measurements, anesthesia induction and surgery will commence. Throughout surgery, blood pressure, heart rate, and brain activity will be continuously recorded. After the surgical procedure, anesthesia emergence and mental status will be assessed. Preoperative evaluation data and intraoperative recordings will be used solely for research purposes, with patient identity information remaining confidential.

Detailed Description

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Perioperative cognitive decline and delirium occur more frequently in the geriatric population undergoing surgery. International guidelines recommend monitoring anesthesia depth to reduce the risk of postoperative cognitive dysfunction. Anesthesia depth is commonly measured using non-invasive electroencephalography (EEG)-based methods, such as the Bispectral Index (BIS).

Previous studies have predominantly utilized processed EEG monitors that generate numerical values for tracking anesthesia depth. However, in this study, anesthesia depth will be monitored using both the standard numerical BIS index and the Density Spectral Array (DSA) mode, an advanced feature of the BIS device. To date, no studies have simultaneously examined BIS and DSA modes in relation to cognitive function and the recovery process.

The use of advanced monitoring techniques may serve as a valuable resource for future research, particularly in optimizing anesthetic management for geriatric patients with reduced cognitive reserve. This study aims to evaluate the effects of different intraoperative anesthesia depth monitoring approaches, including hemodynamic monitoring, numerical BIS values, and DSA functions. The primary objective is to determine the optimal anesthesia monitoring strategy that minimizes intraoperative hypotension, burst suppression, and postoperative delirium.

Conditions

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Geriatric Patient Care Improvement Postoperative Delirium (POD) Burst Suppression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Group 1: Anaesthesia depth monitoring according to hemodynamic values Group 2: Anaesthesia depth monitoring according to numeric BIS values (numbers between 40 to 60 is aimed) Group 3: Anaesthesia depth monitoring according to DSA function (avoiding obvious burst supression and keeping alpha band in high frequency)
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Hemodynamic-Guided Group

Anesthesia depth monitoring will be managed according to hemodynamic parameters, primarily avoiding hypotension.

Group Type ACTIVE_COMPARATOR

Control Group: Standard Hemodynamic Monitoring

Intervention Type OTHER

Anesthesia depth monitoring based on hemodynamic values without additional processed EEG guidance.

BIS-Guided Group

Anaesthesia depth monitoring according to numeric BIS index values

Group Type ACTIVE_COMPARATOR

Processed Electroencephalogram (BIS Index)

Intervention Type DEVICE

Anaesthesia depth monitoring according to numeric BIS index values.

DSA-Guided Group

Anesthesia depth monitoring using the Density Spectral Array (DSA) function of the BIS monitor.

Group Type ACTIVE_COMPARATOR

Processed Electroencephalogram (DSA Mode)

Intervention Type DEVICE

Anaesthesia depth monitoring according to density spectral array functions

Interventions

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Control Group: Standard Hemodynamic Monitoring

Anesthesia depth monitoring based on hemodynamic values without additional processed EEG guidance.

Intervention Type OTHER

Processed Electroencephalogram (BIS Index)

Anaesthesia depth monitoring according to numeric BIS index values.

Intervention Type DEVICE

Processed Electroencephalogram (DSA Mode)

Anaesthesia depth monitoring according to density spectral array functions

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* 65 years and older
* Elective spinal surgeries
* ASA status I-III

Exclusion Criteria

* Emergent surgeries
* ASA status IV-V
* Prediagnosed delirium and or dementia
* Inability to give consent
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Aslıhan Güleç

OTHER

Sponsor Role lead

Responsible Party

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Aslıhan Güleç

MD, Specialist in Anesthesiology and Reanimation

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Zerrin Ozkose Satirlar, Professor

Role: STUDY_DIRECTOR

Gazi University

Locations

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Gazi University School of Medicine

Ankara, , Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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Aslihan Gulec Kilic, MD

Role: CONTACT

+905072709000

Gozde Inan, Associate Professor

Role: CONTACT

+905358105620

Facility Contacts

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Aslihan Gulec Kilic, MD

Role: primary

+905072709000

Gozde Inan, Associate Professor

Role: backup

+905358105620

References

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Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures. Anesthesiology. 2015 Oct;123(4):937-60. doi: 10.1097/ALN.0000000000000841.

Reference Type BACKGROUND
PMID: 26275092 (View on PubMed)

Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Audisio R, Borozdina A, Cherubini A, Jones C, Kehlet H, MacLullich A, Radtke F, Riese F, Slooter AJ, Veyckemans F, Kramer S, Neuner B, Weiss B, Spies CD. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017 Apr;34(4):192-214. doi: 10.1097/EJA.0000000000000594.

Reference Type BACKGROUND
PMID: 28187050 (View on PubMed)

Wildes TS, Mickle AM, Ben Abdallah A, Maybrier HR, Oberhaus J, Budelier TP, Kronzer A, McKinnon SL, Park D, Torres BA, Graetz TJ, Emmert DA, Palanca BJ, Goswami S, Jordan K, Lin N, Fritz BA, Stevens TW, Jacobsohn E, Schmitt EM, Inouye SK, Stark S, Lenze EJ, Avidan MS; ENGAGES Research Group. Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. JAMA. 2019 Feb 5;321(5):473-483. doi: 10.1001/jama.2018.22005.

Reference Type BACKGROUND
PMID: 30721296 (View on PubMed)

Chen YC, Hung IY, Hung KC, Chang YJ, Chu CC, Chen JY, Ho CH, Yu CH. Incidence change of postoperative delirium after implementation of processed electroencephalography monitoring during surgery: a retrospective evaluation study. BMC Anesthesiol. 2023 Oct 4;23(1):330. doi: 10.1186/s12871-023-02293-9.

Reference Type BACKGROUND
PMID: 37794315 (View on PubMed)

Shao YR, Kahali P, Houle TT, Deng H, Colvin C, Dickerson BC, Brown EN, Purdon PL. Low Frontal Alpha Power Is Associated With the Propensity for Burst Suppression: An Electroencephalogram Phenotype for a "Vulnerable Brain". Anesth Analg. 2020 Nov;131(5):1529-1539. doi: 10.1213/ANE.0000000000004781.

Reference Type BACKGROUND
PMID: 33079876 (View on PubMed)

Fritz BA, Kalarickal PL, Maybrier HR, Muench MR, Dearth D, Chen Y, Escallier KE, Ben Abdallah A, Lin N, Avidan MS. Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium. Anesth Analg. 2016 Jan;122(1):234-42. doi: 10.1213/ANE.0000000000000989.

Reference Type BACKGROUND
PMID: 26418126 (View on PubMed)

Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008 Jan;108(1):18-30. doi: 10.1097/01.anes.0000296071.19434.1e.

Reference Type BACKGROUND
PMID: 18156878 (View on PubMed)

Other Identifiers

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Gazi-2024 -1816

Identifier Type: -

Identifier Source: org_study_id

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