With this trial we aim to characterize the intraoperative signatures of the Direct-Current-Electroencephalogram (DC-EEG) of elderly patients developing a PostOperative Delirium (POD) compared to patients who do not develop a POD. We hereby intend to gain a better understanding of the electrical potential at the blood-brain-barrier (measured with DC-EEG) during general anaesthesia. Second, we want to study the effect of age on the DC-EEG by comparing a younger (18-30y) to an elderly cohort (\>70). Third, we aim to couple the DC-EEG signatures to blood sample analysis in order to understand the relationship between metabolic, inflammatory and vascular reaction with the intraoperative DC-EEG.
In order to study the intraoperative DC-EEG signatures of elderly patients coupled with lab data to evaluate the role of the age-dependent blood-brain barrier (BBB) dysfunction in general anesthesia and its meaning in POD pathophysiology following protocol will be followed: 1. On the day of the surgery the 21 DC-EEG sintered Ag/AgCl (silver chloride) electrodes will be placed before the start of anesthesia following the 10-20-system. 2. The first blood sample will be collected via the routinely placed intravenous catheter. 3. During the induction of anesthesia special care will be given to the exact time of loss of consciousness (LOC), defined with the suppression of the lid closure reflex. 4. Markers will be set at important time points of the anesthetic care (Baseline, start of analgesia/anesthesia, LOC, intubation, beginning of surgical procedure, end of anesthesia, regain of consciousness, extubation, admission recovery room). 5. Shortly after consciousness has vanished (5-10 minutes), a second blood sample will be drawn. 6. The DC-EEG recording will last until one hour after arrival at the recovery room, during which NuDesc score will be assessed every 15 minutes. 7. A third blood sample is to be collected in the recovery room. In the five days following surgery patients will be visited in the morning and in the evening to screen delirious symptoms with the help of standardized scores (NuDesc, DSM V, DDS). If patients are staying on the intensive care unit the CAM-ICU will be used. Blood sample analysis will include blood cells count, electrolytes, inflammatory markers, cholesterols, proteins, structural BBB markers and markers of neuronal damage.
Study Type
OBSERVATIONAL
Enrollment
24
Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin
Berlin, Germany
1. DC-Shift (µV/sec) in the perioperative DC-EEG.
Full-brain DC-EEG with 21 electrodes placed preoperatively following the 10/20-System and recording until one hour after regain of consciousness.
Time frame: From the beginning of general anaesthesia to one hour after regain of consciousness
Incidence of Postoperative Delirium
Postoperative Delirium is defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and/or as ≥ 2 cumulative points in the nursing Delirium Screening Scale (Nu-DESC) and/or a positive Confusion Assessment Method (CAM) and/or Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score and/or patient chart review that shows descriptions of Delirium.
Time frame: Patients will be follow until hospital discharge, or maximal until postoperative day 5
Additional perioperative DC-EEG signatures: morphology, polarity (positive/negative), amplitude (µV)
Full-brain DC-EEG with 21 electrodes placed preoperatively following the 10/20-System and recording until one hour after regain of Consciousness.
Time frame: From the beginning of general anaesthesia to one hour after regain of consciousness
DC-EEG signatures in young (18-30) vs. elderly (>70) patients
Full-brain DC-EEG with 21 electrodes placed preoperatively following the 10/20-System and recording until one hour after regain of consciousness
Time frame: From the beginning of general anaesthesia to one hour after regain of consciousness
Analysis of pre-, intra- and postoperative blood parameters
Blood samples will be drawn before the start of general anesthesia, shortly after loss of consciousness and in the recovery room.
Time frame: : From shortly before the beginning of general anaesthesia to maximum one hour after arrival in the recovery room
Peri-operative, full-brain overall EEG band power
Full-brain EEG recording with surface Ag/AgCl electrodes Spectral analysis by Matlab Code/Lab Chart
Time frame: Up to the end of stay in the recovery room
Burst suppression duration
Full-brain EEG recording with surface electrodes, raw EEG analysis
Time frame: During anesthesia procedure
Duration of Delirium
Diagnostic and Statistical Manual of Mental Disorders (DSM-V); Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Confusion Assessment Method (CAM), Chart Review
Time frame: Participants will be followed for the duration of hospital stay, or maximal until postoperative day 5
Intensive care unit length of stay
The stay is measured in days.
Time frame: Participants will be followed for the duration of intensive care unit stay, an expected average of 5 days
Hospital length of stay
The stay is measured in days.
Time frame: Participants will be followed for the duration of hospital stay, an expected average of 7 days
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