search
Back to results

Effect of Remifentanil on Postoperative Cognition Function in Patients Undergoing Major Abdominal Surgery

Primary Purpose

Patients Undergoing Major Abdominal Surgery, Postoperative Confusion

Status
Completed
Phase
Phase 4
Locations
Italy
Study Type
Interventional
Intervention
Remifentanil
Fentanyl
Sponsored by
Catholic University of the Sacred Heart
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional screening trial for Patients Undergoing Major Abdominal Surgery focused on measuring Major abdominal surgery, analgesic method, Fentanyl, Remifentanyl, Postoperative cognitive disorder, Pro and anti inflammatory cytokines

Eligibility Criteria

60 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age over 60 years
  • Patients undergoing major abdominal surgery, in General Anesthesia
  • ASA class status I-III

Exclusion Criteria:

  • History of allergy to drugs used in the study
  • Mini-Mental State Examination (MMSE) value < 26
  • Expected duration of anesthesia less than 1 hour and more than 4 hours
  • Presence of a cognitive disorder severity of overt such as to prevent collaboration of the patient
  • Presence of severe electrolyte disturbances or not controlled bool glucose levels
  • History of pain or cerebral vascular disease on the basis of significant carotid or cerebral artery stenosis, to be verified by scanning eco-color doppler
  • Habitual use of tranquillizers or other drugs affecting the central nervous system
  • Difficulties in the management of the airways, such as to make the necessary changes in anesthesia technique
  • Severe hypotension or hypertension or other vascular disorders, particularly thrombotic events or bleeding during surgery or in the perioperative period
  • Bleeding that requires blood transfusion
  • Medication needs higher or lower than that indicated in the protocol to ensure the depth of hypnosis, indicated by values of BIS targets
  • Refusal by the patient

Sites / Locations

  • Policlinico Universitario "A.Gemelli"

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Remifentanyl

Fentanyl

Arm Description

In group A induction of anesthesia will be performed with Propofol (2mg/kg), Cisatracurium (0.15mg/kg)and continous infusion of Remifentanil (0.15mcg/kg/min).Anesthesia will be maintained by Sevoflurane with oxygen (Fi=40%)and air, with a MAC value to maintain BIS between 40 and 60. Intraoperative analgesia will be obtained with Remifentanil 0.15-0.25mcg/kg/min. Additional boluses of Cisatracurium (0.02mcg/kg)will be administered as needed during surgery. At the beginning of closure of the peritoneum bolus of morphine (0.1mg/kg)and acetaminophen 1g will be administered. Propofol and remifentanil infusions will be interrupted at the end of wound closure.

In group B anesthesia will be induced by Propofol (2mg/kg), Fentanyl (2mcg/kg)and Cisatracurium (0.15mg/kg). Anesthesia will be maintained by Sevoflurane, oxygen (Fi=40%) and air and boluses of Fentanyl (50mcg). additional boluses of Cisatracurium (0.02mg/kg)will be administered as needed during surgery. At the beginning of closure of the peritoneum acetaminophen 1g will be administered.

Outcomes

Primary Outcome Measures

Rey verbal memory test of words before and after major abdominal surgery
In test of Rey to the subject is presented for 5 times the same list of 15 bisyllabic words or trisillabic common use of which he must recall as many as possible within 1 minute; after about 15 minutes the patient, meanwhile distracted by the test , must again try to remember the greatest number possible without a further reading. The maximum possible score of the first phase of the test is an expression of the ability of short term memory of the subject, the result of the test is repeated at a distance of 15 minutes is indicative of its storage capacity, to intermediate term.
Stroop Test before and after surgery
In the Stroop Test patient is instructed to read a random sequence of adjectives "green", "red", "blue" written in black font, then he refers the colour of a succession of circumferences filled of the three colors above in random order; finally, another random succession of three words "green", "red", "blue" written in three characters of the same colors, but not associated with corresponding adjective. Number of errors that the subject does in reading is an indication of its ability to attention

Secondary Outcome Measures

Quantitative determination of serum pro and anti inflammatory cytokines before and after surgery
Blood samples will be made for the quantitative determination of serum cytokines IL-1β, IL-6, IL-8, TNF-α, IL-10 and IL-12. Determinations will be given by Multiplex Elisa method.

Full Information

First Posted
June 21, 2012
Last Updated
June 22, 2012
Sponsor
Catholic University of the Sacred Heart
search

1. Study Identification

Unique Protocol Identification Number
NCT01627873
Brief Title
Effect of Remifentanil on Postoperative Cognition Function in Patients Undergoing Major Abdominal Surgery
Official Title
Effect of Remifentanil on Postoperative Cognitive Function in Patients Undergoing Major Abdominal Surgery
Study Type
Interventional

2. Study Status

Record Verification Date
June 2012
Overall Recruitment Status
Completed
Study Start Date
August 2009 (undefined)
Primary Completion Date
July 2011 (Actual)
Study Completion Date
December 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Catholic University of the Sacred Heart

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to investigate the effects of two different analgesic methods (Fentanyl vs Remifentanil) during major abdominal surgery on postoperative cognitive status of patients.
Detailed Description
The purpose of this study is to investigate the effects of two different analgesic methods (Fentanyl vs Remifentanil) during major abdominal surgery on postoperative cognitive status of patients. In particular, whether there is a correlation between type of anesthesia and the appearance of postoperative cognitive disorder (POCD), including type of anesthesia and levels of pro and anti inflammatory cytokines and investigate whether there is an association between presence or absence of POCD and cytokines levels

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Patients Undergoing Major Abdominal Surgery, Postoperative Confusion
Keywords
Major abdominal surgery, analgesic method, Fentanyl, Remifentanyl, Postoperative cognitive disorder, Pro and anti inflammatory cytokines

7. Study Design

Primary Purpose
Screening
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
622 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Remifentanyl
Arm Type
Experimental
Arm Description
In group A induction of anesthesia will be performed with Propofol (2mg/kg), Cisatracurium (0.15mg/kg)and continous infusion of Remifentanil (0.15mcg/kg/min).Anesthesia will be maintained by Sevoflurane with oxygen (Fi=40%)and air, with a MAC value to maintain BIS between 40 and 60. Intraoperative analgesia will be obtained with Remifentanil 0.15-0.25mcg/kg/min. Additional boluses of Cisatracurium (0.02mcg/kg)will be administered as needed during surgery. At the beginning of closure of the peritoneum bolus of morphine (0.1mg/kg)and acetaminophen 1g will be administered. Propofol and remifentanil infusions will be interrupted at the end of wound closure.
Arm Title
Fentanyl
Arm Type
Active Comparator
Arm Description
In group B anesthesia will be induced by Propofol (2mg/kg), Fentanyl (2mcg/kg)and Cisatracurium (0.15mg/kg). Anesthesia will be maintained by Sevoflurane, oxygen (Fi=40%) and air and boluses of Fentanyl (50mcg). additional boluses of Cisatracurium (0.02mg/kg)will be administered as needed during surgery. At the beginning of closure of the peritoneum acetaminophen 1g will be administered.
Intervention Type
Drug
Intervention Name(s)
Remifentanil
Intervention Description
In group A induction of anesthesia will be performed with Propofol (2mg/kg), Cisatracurium (0.15mg/kg)and continous infusion of Remifentanil (0.15mcg/kg/min).Anesthesia will be maintained by Sevoflurane with oxygen (Fi=40%)and air, with a MAC value to maintain BIS between 40 and 60. Intraoperative analgesia will be obtained with Remifentanil 0.15-0.25mcg/kg/min. Additional boluses of Cisatracurium (0.02mcg/kg)will be administered as needed during surgery. At the beginning of closure of the peritoneum bolus of morphine (0.1mg/kg)and acetaminophen 1g will be administered. Propofol and remifentanil infusions will be interrupted at the end of wound closure.
Intervention Type
Drug
Intervention Name(s)
Fentanyl
Intervention Description
In group B anesthesia will be induced by Propofol (2mg/kg), Fentanyl (2mcg/kg)and Cisatracurium (0.15mg/kg). Anesthesia will be maintained by Sevoflurane, oxygen (Fi=40%) and air and boluses of Fentanyl (50mcg). additional boluses of Cisatracurium (0.02mg/kg)will be administered as needed during surgery. At the beginning of closure of the peritoneum acetaminophen 1g will be administered.
Primary Outcome Measure Information:
Title
Rey verbal memory test of words before and after major abdominal surgery
Description
In test of Rey to the subject is presented for 5 times the same list of 15 bisyllabic words or trisillabic common use of which he must recall as many as possible within 1 minute; after about 15 minutes the patient, meanwhile distracted by the test , must again try to remember the greatest number possible without a further reading. The maximum possible score of the first phase of the test is an expression of the ability of short term memory of the subject, the result of the test is repeated at a distance of 15 minutes is indicative of its storage capacity, to intermediate term.
Time Frame
participants will be followed the day before and after surgery and for the duration of hospital stay, an expected average of 5 days
Title
Stroop Test before and after surgery
Description
In the Stroop Test patient is instructed to read a random sequence of adjectives "green", "red", "blue" written in black font, then he refers the colour of a succession of circumferences filled of the three colors above in random order; finally, another random succession of three words "green", "red", "blue" written in three characters of the same colors, but not associated with corresponding adjective. Number of errors that the subject does in reading is an indication of its ability to attention
Time Frame
participants will be followed the day before and after surgery and for the duration of hospital stay, an expected average of 5 days
Secondary Outcome Measure Information:
Title
Quantitative determination of serum pro and anti inflammatory cytokines before and after surgery
Description
Blood samples will be made for the quantitative determination of serum cytokines IL-1β, IL-6, IL-8, TNF-α, IL-10 and IL-12. Determinations will be given by Multiplex Elisa method.
Time Frame
participants will be followed the day before and after surgery and for the duration of hospital stay, an expected average of 5 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
60 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age over 60 years Patients undergoing major abdominal surgery, in General Anesthesia ASA class status I-III Exclusion Criteria: History of allergy to drugs used in the study Mini-Mental State Examination (MMSE) value < 26 Expected duration of anesthesia less than 1 hour and more than 4 hours Presence of a cognitive disorder severity of overt such as to prevent collaboration of the patient Presence of severe electrolyte disturbances or not controlled bool glucose levels History of pain or cerebral vascular disease on the basis of significant carotid or cerebral artery stenosis, to be verified by scanning eco-color doppler Habitual use of tranquillizers or other drugs affecting the central nervous system Difficulties in the management of the airways, such as to make the necessary changes in anesthesia technique Severe hypotension or hypertension or other vascular disorders, particularly thrombotic events or bleeding during surgery or in the perioperative period Bleeding that requires blood transfusion Medication needs higher or lower than that indicated in the protocol to ensure the depth of hypnosis, indicated by values of BIS targets Refusal by the patient
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Germano De Cosmo, Associated Professor
Organizational Affiliation
Catholic University of the Sacred Heart - Rome
Official's Role
Study Director
Facility Information:
Facility Name
Policlinico Universitario "A.Gemelli"
City
Rome
ZIP/Postal Code
00168
Country
Italy

12. IPD Sharing Statement

Citations:
PubMed Identifier
10935000
Citation
Rasmussen LS, Moller JT. Central nervous system dysfunction after anesthesia in the geriatric patient. Anesthesiol Clin North Am. 2000 Mar;18(1):59-70, vi. doi: 10.1016/s0889-8537(05)70149-8.
Results Reference
background
PubMed Identifier
9861139
Citation
Dodds C, Allison J. Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth. 1998 Sep;81(3):449-62. doi: 10.1093/bja/81.3.449. No abstract available.
Results Reference
background
PubMed Identifier
10603995
Citation
Rasmussen LS. Perioperative cognitive decline: the extent of the problem. Acta Anaesthesiol Belg. 1999;50(4):199-204. No abstract available.
Results Reference
background
PubMed Identifier
7762856
Citation
Parikh SS, Chung F. Postoperative delirium in the elderly. Anesth Analg. 1995 Jun;80(6):1223-32. doi: 10.1097/00000539-199506000-00027.
Results Reference
background
PubMed Identifier
9248516
Citation
Moller JT. Cerebral dysfunction after anaesthesia. Acta Anaesthesiol Scand Suppl. 1997;110:13-6. doi: 10.1111/j.1399-6576.1997.tb05484.x. No abstract available.
Results Reference
background
PubMed Identifier
10800812
Citation
Diegeler A, Hirsch R, Schneider F, Schilling LO, Falk V, Rauch T, Mohr FW. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. Ann Thorac Surg. 2000 Apr;69(4):1162-6. doi: 10.1016/s0003-4975(99)01574-x.
Results Reference
background
PubMed Identifier
12473019
Citation
Wilson CJ, Finch CE, Cohen HJ. Cytokines and cognition--the case for a head-to-toe inflammatory paradigm. J Am Geriatr Soc. 2002 Dec;50(12):2041-56. doi: 10.1046/j.1532-5415.2002.50619.x.
Results Reference
background
PubMed Identifier
17325501
Citation
Wan Y, Xu J, Ma D, Zeng Y, Cibelli M, Maze M. Postoperative impairment of cognitive function in rats: a possible role for cytokine-mediated inflammation in the hippocampus. Anesthesiology. 2007 Mar;106(3):436-43. doi: 10.1097/00000542-200703000-00007.
Results Reference
background
PubMed Identifier
16508385
Citation
Buvanendran A, Kroin JS, Berger RA, Hallab NJ, Saha C, Negrescu C, Moric M, Caicedo MS, Tuman KJ. Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology. 2006 Mar;104(3):403-10. doi: 10.1097/00000542-200603000-00005. Erratum In: Anesthesiology. 2006 Apr;104(4):900.
Results Reference
background
PubMed Identifier
18005471
Citation
Winterhalter M, Brandl K, Rahe-Meyer N, Osthaus A, Hecker H, Hagl C, Adams HA, Piepenbrock S. Endocrine stress response and inflammatory activation during CABG surgery. A randomized trial comparing remifentanil infusion to intermittent fentanyl. Eur J Anaesthesiol. 2008 Apr;25(4):326-35. doi: 10.1017/S0265021507003043. Epub 2007 Nov 16.
Results Reference
background
PubMed Identifier
9525362
Citation
Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998 Mar 21;351(9106):857-61. doi: 10.1016/s0140-6736(97)07382-0. Erratum In: Lancet 1998 Jun 6;351(9117):1742.
Results Reference
background
PubMed Identifier
15684252
Citation
Rohan D, Buggy DJ, Crowley S, Ling FK, Gallagher H, Regan C, Moriarty DC. Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly. Can J Anaesth. 2005 Feb;52(2):137-42. doi: 10.1007/BF03027718.
Results Reference
background
PubMed Identifier
12078822
Citation
Collie A, Darby DG, Falleti MG, Silbert BS, Maruff P. Determining the extent of cognitive change after coronary surgery: a review of statistical procedures. Ann Thorac Surg. 2002 Jun;73(6):2005-11. doi: 10.1016/s0003-4975(01)03375-6.
Results Reference
background

Learn more about this trial

Effect of Remifentanil on Postoperative Cognition Function in Patients Undergoing Major Abdominal Surgery

We'll reach out to this number within 24 hrs