Modulating Surgery-Induced Blood-Brain Barrier Disruption in Elderly
Delirium, Postoperative
About this trial
This is an interventional prevention trial for Delirium, Postoperative focused on measuring Postoperative delirium, dexmedetomidine, lidocaine, neuroinflammation, CPAR, blood brain barrier
Eligibility Criteria
Inclusion Criteria: American Society of Anesthesiologists (ASA) physical status classification I-III Undergoing elective open pancreatoduodenectomy Voluntary participation in the trial and signed informed consent Exclusion Criteria: Sinus bradycardia (heart rate (HR) <50 beats per minute (bpm)), Adams-Stokes syndrome, sick sinus or Wolff-Parkinson-White syndrome, or second-degree trioventricular block and over. Concurrent treatment with a class 1 antiarrhythmic or amiodarone) History of hypersensitivity reactions or contraindications to the study drugs (dexmedetomidine or lidocaine). Patient at personal of familial risk of malignant hyperthermia and porphyria Body mass index (BMI) ˃40 kg/m2 Patients with coagulopathy (INR 1.5 or more, platelet count less than 75000/ul) or other contraindications to spinal tapping, or on anticoagulants that would preclude safe lumbar punctures. History of severe hepatic (Childs-Pugh Score > Class A ) or renal (glomerular filtration rate <30m)/min×1.73m2) disorders. Severe audio-visual impairments, or inability to speak precluding communication. Evidence of preoperative delirium (Confusion Assessment Method, CAM) History of uncontrolled seizures. Patients on immunosuppressants (e.g., steroids) or immunomodulatory therapy, chemotherapeutic agents with known cognitive effects. Patients taking the following drugs that are moderate-strong inhibitors of the CYP1A2 and CYP3A4 metabolic pathways within 72 hours prior to surgery
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Placebo Comparator
Dexmedetomidine group
Lidocaine group
Control group
Patients in the dexmedetomidine group will be administered a bolus of 0.3 ug/kg intravenous dexmedetomidine over 10 min before anesthetic induction. After bolus injection, a continuous infusion of 0.3 ug/kg/hr of intravenous dexmedetomidine will be administered until the end of surgery.
Patients in the lidocaine group will receive a bolus of 1.5 mg/kg intravenous lidocaine over 10 min before induction of anesthesia. A continuous infusion of 1.5 mg/kg/hour of systemic lidocaine will be administered until the end of the surgery.
Patients in the control group will be administered equal volumes of 0.9% saline using the identical application scheme.