Optimized Anesthesia to Reduce Postoperative Cognitive Impairment in the Elderly

Erasme University Hospital41 enrolled

Overview

The aim of this study is to demonstrate that in elderly and frail patients, a narrower control of intraoperative blood pressure (BP) by the use of a continuous and noninvasive BP monitoring, coupled with an adequate depth of anesthesia, will reduce the incidence of postoperative cognitive impairment and the hospital length of stay.

Postoperative cognitive impairment (delirium and cognitive dysfunction) are frequent and feared complications in the elderly; they increase the postoperative morbidity and mortality, worsen the cognitive and functional outcome with loss of independence and increase the hospitalization length and costs . However, the etiology of these postoperative cognitive impairment, although probably multifactorial, remains unclear and strongly debated. The investigators hypothesize that excessive anesthesia depths associated with intraoperative hypotension may play a critical role in the pathogenesis of cognitive impairment following surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

Conditions

Elderly ; Moderate Risk Surgery

Interventions

Depth of anesthesia monitoring (BIS, Covidien USA) and Continus non invasive blood pressure monitoring (Clearsight, Edwards LifeScience, USA)DEVICE

moderate risk surgeryPROCEDURE

Eligibility

Sex: ALLMin age: 70 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * elderly patients (over the age of 70) undergoing elective moderate risk surgery requiring a general anesthesia * Patients who provide written informed consent * patient fluent in french Exclusion Criteria: * Patients under 70 years of age * Surgery under locoregional anesthesia or emergent surgery or minor risk surgery * Patients requiring invasive blood pressure monitoring (for medical reason or high risk surgery) * Patients with arrhythmia and/or atrial fibrillation * Patients with preoperative delirium or cognitive dysfunction (moca test \< 26) * Patients not fluent in French * Patients without the capacity to give written informed consent or refusal of consent * Patients undergoing surgery or included in another protocol within 3 months

Locations (1)

Erasme Hospital

Brussels, Belgium

Outcomes

Primary Outcomes

postoperative delirium detected by the Confusion Assessment Method (CAM)

Screening of postoperative delirium by the CAM, every day until the 3rd postoperative day

Time frame: 3 day postoperative

Secondary Outcomes

postoperative change in cognitive function detected by a battery of neuropsychological test.

Time frame: baseline and 1 week and 3 month postoperative

Data from ClinicalTrials.gov

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