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This study aimed to determine whether targeting bispectral index (BIS) readings of 55 (light anaesthesia) was associated with a lower incidence of delirium, dementia (POD), POCD and mortality but higher rates of awareness and complications than a standard of care anaesthesia blinded to depth monitoring.
Design: Randomised-controlled, double blind study, monocentric Setting: Level 2 medical center, major surgery (non cardiac) Ethics: Ethical approval for this study (Ethikkommission II der Ruprecht-Karls-Universität Heidelberg 2013-627N-MA) was provided by the Ethical Committee II University Medicine Mannheim, University of Heidelberg, Germany (Chairperson Prof W. Striebel) on Mai 12th 2008.
Patients: n=130, aged > 70y Intervention: Light anesthesia (BIS 55 +/-5) vs. Standard of Care (BIS- blinded) Main outcome measures: Incidence of awareness, delirium, postoperative cognitive deficit (POCD), dementia (POD), memory (MAT with a computerized score for verbal working&short term, figural working&short term memories and well as attention level) Second aims: mortality, complications
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Bis Guided light anesthesia | Experimental | Patients are monitored by bispectral index and held under light anesthesia (BIS level 45 to 60) |
|
| Standard of Care | Placebo Comparator | Patients receive standard of care anesthesia, BIS monitor was covered with a blind |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| BIS guidance of anesthesia | Device | Anesthesia is to be directed to a specific (light) level by the dosage of administered hypnotics and analgesics |
|
| Measure | Description | Time Frame |
|---|---|---|
| postoperative delirium by NUDESC | in the hospital with NUDESC Score | 6 to 24 months |
| postoperative dementia and cognitive deficit By MMSE and MAT Test | in the hospital by MMSE and MAT (automated computerized test), after discharge by a standardized questionnaire | 6 to 24 months |
| awareness, memory function | implicit and explicit memory for intraoperative wakefulness and memory functions in general as changing conditions due to anesthesia | 1 to 3 days postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| mortality and morbidity | death rate (in hospital and longterm mortality (death/month)) and complication rate (in hospital and longterm morbidity (complications/month)) | 6 to 24 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinic of Anesthesiology and Critical Care Medicine, Faculty of Clinical Medicine MAnnheim, University of Heidelberg, Germany | Mannheim | Baden-Wurttemberg | 68167 | Germany |
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| ID | Term |
|---|---|
| D003693 | Delirium |
| D058926 | Intraoperative Awareness |
| ID | Term |
|---|---|
| D003221 | Confusion |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D059039 | Standard of Care |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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Randomised-controlled, double blind study, monocentric
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group blinding for all of the above except for staff anesthesiologist of the light anesthesia group
| Standard of Care | Other | Anesthesia is administered as usual |
|
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| D007431 | Intraoperative Complications |
| D010335 | Pathologic Processes |