The purpose of this study is to study aspects of autonomic cardiovascular control and the level of stress hormones and inflammatory markers in saliva or serum, in elderly patients exposed to elective, major abdominal surgery, with or without postoperative delirium, to explore the hypothesis that delirium may be the result of aberrant stress responses.
Patients admitted for elective, major, abdominal surgery will be tested with a head-up tilting to 20 degrees for 15 minutes preoperatively and again on the second postoperative day. Haemodynamic variables will be registered by the device TaskForceMonitor which monitors heart rate (HR), electrocardiography (ECG), blood pressure and stroke volume continuously and non-invasively. Background variables (including demographics, comorbidity and simple cognitive tests) and daily variables (including delirium assessments) will be registered. Blood and saliva samples will be drawn preoperatively and postoperatively to measure levels of stress hormones and inflammatory markers.
Study Type
OBSERVATIONAL
Enrollment
3
Patients 65 years or older scheduled for abdominal surgery at Oslo University Hospital
Oslo University Hospital, Ullevaal
Oslo, Norway
Change in orthostatic cardiovascular responses
Change in orthostatic cardiovascular responses (head-up tilt test) pre- and postoperatively in patients with and without postoperative delirium will be evaluated based on measurements of heart rate, systolic blood pressure (BP), mean BP, diastolic BP, stroke index, total peripheral resistance index, end-diastolic volume index, and acceleration index.
Time frame: Baseline and postoperatively at surgical ward (expected second postoperative day)
Barthel Activities of Daily Living (ADL) Scale
Score from 0-20 points
Time frame: Baseline
Nottingham Extended Activity of Daily Living (NEADL) Scale
Score from 0-66 points.
Time frame: Baseline
Cumulative Illness Rating Scale
Total score from 0-56.
Time frame: Baseline
Dementia
Simple cognitive tests preformed preoperatively, including MMSE, Clock Drawing Test, Trail making A and B and Ten word memory test. Also IQCODE when reliable information is present.
Time frame: Baseline
Delirium
Daily assessing the patient using the Confusion Assessment Method (CAM), shortened version.
Time frame: Baseline and a minimum of 2 days after the second tilt-test, an expected average of 5 days.
Cortisol
Looking for differences in levels of cortisol in saliva (morning samples) pre-and postoperatively in patients developing delirium compared to patients not developing delirium.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Baseline and second postoperative day
Severity of delirium
Daily assessing the patient using MDAS (the memorial delirium assessment scale). Total score from 0-30.
Time frame: Baseline and a minimum of 2 days after the second tilt-test, an expected average of 5 days
Gait speed
Measuring comfortable gait speed at length of 4 meters, best result of 2 tests. Result in meter per second.
Time frame: Baseline