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| Name | Class |
|---|---|
| European Association of Cardiothoracic Anaesthesiologists | UNKNOWN |
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The purpose of this study is to investigate the effects of total intravenous anesthesia versus volatile anesthesia on the perioperative inflammatory response during and after major surgery.
Patients undergoing major surgical procedures, in particular those undergoing cardiac surgery, develop a severe inflammatory response in up to 50% of cases leading to increased mortality and morbidity. The inflammatory response depends on the surgical procedure and on patient related factors like genetic predisposition and co morbidities. However, in vitro studies showed that the type and duration of general anaesthesia also influences the extent of perioperative inflammation.
Comparison: total intravenous anesthesia by propofol is compared to volatile anesthesia by isoflurane with respect to development of perioperative inflammatory response.
The IRAS study is a single centre study, executed in the University Medical Centre Utrecht, The Netherlands. Four different patient groups are included. 1) Patients undergoing coronary artery bypass grafting (CABG) with use of cardiopulmonary bypass (CPB), 2) patients undergoing aorta aneurysm repair via endovascular approach and 3) via conventional open procedure, and 4) patients undergoing surgery for replacement of implantable cardioverter defibrillator (ICD).
The IRAS is a prospective, randomized clinical trial. Patients are randomly assigned to a intravenous or a balanced anaesthesia technique. Peripheral blood samples are drawn before, during and up to 72h after surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 | elective CABG only patients | ||
| 2 | elective ICD replacement surgical patients requiring general anesthesia |
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| Measure | Description | Time Frame |
|---|---|---|
| Perioperative inflammatory response through measurement of expression and responsiveness of Toll-like Receptor (TLR) 2 and 4 of monocytes from full blood samples. | 72 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Parameters of systemic haemodynamics | 72 hours | |
| Need of vasoactive medication to develop predefined haemodynamic goals | 72 hours | |
| Biochemical parameter of myocardial ischaemia and infarction (Troponin-I), measured immediately before and after surgery, 24 hr and 72hr after surgery |
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Inclusion Criteria:
Exclusion Criteria:
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specific surgical patients receiving general anesthesia of university teaching hospital
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| Name | Affiliation | Role |
|---|---|---|
| Cor J Kalkman, Prof MD PhD | University Medical Centre Utrecht, The Netherlands | Study Chair |
| Wolfgang F Buhre, MD PhD | University Medical Centre Utrecht, The Netherlands | Study Director |
| Gerard Pasterkamp, Prof MD PhD | University Medical Centre Utrecht, The Netherlands | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UMC Utrecht, Division of Perioperative Care and Emergency Medicine, Department of Anesthesiology | Utrecht | 3508 GA | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 14522407 | Background | de Kleijn D, Pasterkamp G. Toll-like receptors in cardiovascular diseases. Cardiovasc Res. 2003 Oct 15;60(1):58-67. doi: 10.1016/s0008-6363(03)00348-1. | |
| 15041589 | Background | de Rossi LW, Brueckmann M, Rex S, Barderschneider M, Buhre W, Rossaint R. Xenon and isoflurane differentially modulate lipopolysaccharide-induced activation of the nuclear transcription factor KB and production of tumor necrosis factor-alpha and interleukin-6 in monocytes. Anesth Analg. 2004 Apr;98(4):1007-1012. doi: 10.1213/01.ANE.0000106860.27791.44. |
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| ID | Term |
|---|---|
| D018746 | Systemic Inflammatory Response Syndrome |
| D017202 | Myocardial Ischemia |
| ID | Term |
|---|---|
| D007249 | Inflammation |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012769 | Shock |
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Full blood smaples
| 72 hours |
| Serious adverse events assessed 3 days after surgery, at discharge, 30 days and one year after surgery | 1 year |
| 9822011 | Background | Larsen B, Hoff G, Wilhelm W, Buchinger H, Wanner GA, Bauer M. Effect of intravenous anesthetics on spontaneous and endotoxin-stimulated cytokine response in cultured human whole blood. Anesthesiology. 1998 Nov;89(5):1218-27. doi: 10.1097/00000542-199811000-00023. |
| 25405275 | Derived | Flier S, Concepcion AN, Versteeg D, Kappen TH, Hoefer IE, de Lange DW, Pasterkamp G, Buhre WF. Monocyte hyporesponsiveness and Toll-like receptor expression profiles in coronary artery bypass grafting and its clinical implications for postoperative inflammatory response and pneumonia: An observational cohort study. Eur J Anaesthesiol. 2015 Mar;32(3):177-88. doi: 10.1097/EJA.0000000000000184. |
| 20573633 | Derived | Flier S, Post J, Concepcion AN, Kappen TH, Kalkman CJ, Buhre WF. Influence of propofol-opioid vs isoflurane-opioid anaesthesia on postoperative troponin release in patients undergoing coronary artery bypass grafting. Br J Anaesth. 2010 Aug;105(2):122-30. doi: 10.1093/bja/aeq111. Epub 2010 Jun 23. |
| D006331 |
| Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |