The main purpose of this study is to determine whether a rational strategy of EEG guided multimodal general anesthesia using target specific sedative and analgesics could result in enhanced recovery after anesthesia and surgery, decrease in postoperative delirium, and decrease in long term postoperative cognitive dysfunction up to 6 months following cardiac surgery.
The main purpose of this study is to determine whether a rational strategy of EEG guided multimodal general anesthesia using target specific sedative and analgesics could result in enhanced recovery after anesthesia and surgery, decrease in postoperative delirium, and decrease in long term postoperative cognitive dysfunction up to 6 months following cardiac surgery. Specific Aim 1: The feasibility of implementing multimodal general anesthesia strategy in the Operating Rooms (OR) Specific Aim 2: The feasibility of implementing EEG guided sedation until extubation in the Intensive Care Unit (ICU) Specific Aim 3: The enhancement of recovery after surgery (shorter ventilation time, ICU stay, hospital length of stay) Specific Aim 4: To estimate the effect size of decrease in postoperative day (POD) and postoperative cognitive dysfunction (POCD) to power future large randomized trials
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
22
Intraoperative bilateral PIFB block with 20 mL of 0.25% Ropivicaine on either side of the sternum after anesthetic induction but before surgical incision
Intraoperative infusion
Intraoperative infusion
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
Incidence of Delirium
Incidence of delirium will be analyzed in patients treated with the multi-modal approach. Delirium will be defined as an acute change in pre-operative baseline condition with additional features of inattention and either disorganized thinking and altered loss of consciousness, as defined by the Confusion Assessment Method (CAM)Assessment Method (CAM) algorithm postoperatively until discharge.
Time frame: Participants will be followed for the duration of the hospital stay, an average of 5 days
Time to extubation
Time to extubation will be noted from ICU data
Time frame: Time of ICU admission until time of extubation in ICU, an average of 6 hours
Montreal Cognitive Assessment (MoCA)
MoCA scores (total possible score is 30 points; a score of 26 or above is considered normal) at discharge will be reported in order to assess the occurrence of postoperative cognitive decline. Study staff trained in administering the assessments will collect the data.
Time frame: On the day of discharge, an average of 6 days
Pain scores
Patient reported pain scores on a scale from 0-10 (0 no pain,10 extreme pain), until discharge for the index admission.
Time frame: At 4-8 hourly intervals every day until discharge, an average of 6 days
Total opioid and supplemental analgesic consumption
The total opioid dosage and supplemental analgesic dosage received in the first 48 hours postoperatively will be abstracted from the medical record.
Time frame: 48 hours, post-operative
ICU
Total duration of stay in ICU for the index admission
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Intraoperative infusion
Intraoperative intermittent bolus
Intraoperative infusion
Intraoperative inhaled as needed
Post-operative infusion
Post-operative infusion
Perioperative monitoring
Time frame: Time of ICU admission until time of discharge to hospital floor; through the hospital stay, an average of 5 days
ICU/hospital length of stay
Their stay in the hospital for the index admission
Time frame: Time of stay in the hospital until discharge to floor or rehab, an average of 5 days
In-hospital complications
stroke, myocardial infarction (MI), acute kidney injury, pneumonia, reintubation, congestive heart failure, sepsis, reopening of sternum and all-cause mortality
Time frame: 7 days post-op on an average
Follow up incidence of delirium
The follow up incidence of delirium will be analyzed at 1 month and 6 months after discharge. Delirium will be defined as an acute change in pre-operative baseline condition with additional features of inattention and either disorganized thinking and altered loss of consciousness, as defined by the MoCA/t-MoCA.
Time frame: Patients will be assessed for delirium at 1 month and 6 months following the date of surgery