The Effects of Anesthesia on Patients Undergoing Surgery for Repair of a Thoracoabdominal Aneurysm.

Johns Hopkins University14 enrolled

Overview

Alzheimer's disease represents a growing public health problem in developed countries. Although the pathogenesis is not clearly defined, accumulation of extracellular amyloid, neurofibrillary tangles and neuronal loss are the hallmarks of Alzheimer's disease. The effect of anesthetic agents on changes in these proteins in humans is not well characterized, but in-vitro evidence suggests that anesthetic agents can accelerate potential pathogenic mechanisms, such as increasing amyloid formation or rates of apoptosis in cultured cells and increasing amyloid levels in mice. Human data on the effect of anesthetic agents on amyloid and tau proteins is limited to a small series of 11 patients and showed a significant increase in tau levels after exposure to anesthetics. In this study the investigators propose to measure CSF and serum biomarkers in a population of patients with normal CSF dynamics, who are undergoing surgery for repair of a thoracoabdominal aneurysm. The investigators will also obtain preliminary data on whether changes in CSF levels of these proteins are associated with postoperative delirium or cognitive change.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

DOUBLE

Enrollment

Conditions

Thoracic Aneurysm Aneurysm Stent

Eligibility

Sex: ALLMin age: 21 YearsMax age: 100 Years

Medical Language ↔ Plain English

Inclusion Criteria: * age 21-100 years of age * Patients presenting for surgical repair of a thoracoabdominal aneurysm * Insertion of a CSF spinal drain for clinically indicated reason Exclusion Criteria: * Patients with pre-existing delirium * Inability to speak and understand English * Severe hearing impairment, resulting in inability to converse * Pregnancy. Pregnancy status will be assessed using a serum pregnancy test during preoperative evaluation as part of the standard of care.

Outcomes

Primary Outcomes

Changes in Cerebrospinal Fluid (CSF) Levels of Tau

Quantitative levels of tau will be measured using ELISA assay technique in pg/ml to compare the differences between the group receiving Propofol and the groups receiving Isoflurane. .

Time frame: From insertion of spinal drain until removal

Changes in CSF Levels of Amyloid

Quantitative levels of amyloid will be measured using ELISA assay technique in pg/ml to compare the differences between the group receiving Propofol and the groups receiving Isoflurane.

Time frame: From insertion of spinal drain until removal

Secondary Outcomes

Number of Participants With Delirium as Assessed by the Confusion Assessment Method (CAM)

Delirium was measured using the Confusion Assessment Method and the Confusion Assessment Method- Intensive Care Unit (CAM-ICU) based upon post-operative location of patient. The patients were divided into to two groups, patients that had an open thoracoabdominal aneurysm repair versus patients that had stenting of their aneurysms. Patients that had stenting of their aneurysms were also randomized to receive either Propofol or Isoflurane as for their anesthetic.

Time frame: Immediately after surgery and at 3 and 12 months post-op