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The impact of anesthesia depths on early postoperative neurocognitive complications after total intravenous anesthesia (TIVA) remains controversial. In some studies investigating TIVA, anesthesiologists mainly achieve the target depth of anesthesia by adjusting the dose of propofol, whereas the doses of opioids remains comparable between different anesthetic depth groups, possibly resulting inadequate analgesia. This study is aimed to investigate the impact of different anesthesia depths maintained by target-controlled infusion of propofol and remifentanil at a fixed ratio on the incidence of early postoperative neurocognitive complications in older patients undergoing noncardiac surgery.
Early postoperative neurocognitive complications are associated with worse perioperative and long-term outcomes, substantially affecting patients' prognosis and recovery and imposing a significant healthcare and economic burden. Bispectral index (BIS) is an objective and quantitative monitoring parameter used to assess patients' depth of anesthesia. Maintenance of general anesthesia under the guidance of BIS monitoring has been shown to reduce the incidence of early postoperative neurocognitive complications following inhalational anesthesia or combined intravenous-inhalational anesthesia.
However, the impact of different depths of anesthesia maintenance on early postoperative neurocognitive complications after total intravenous anesthesia (TIVA) remains controversial. In some studies investigating TIVA, anesthesiologists mainly achieve the target BIS by adjusting the dosage of propofol, whereas the dosage of opioids remains comparable between different anesthetic depth groups. Based on previous studies, the investigators supposed that target-controlled infusion of propofol to remifentanil at a fixed ratio might ensure adequate intraoperative sedation and analgesia and reduce postoperative neurocognitive complications.
This study is aimed to investigate the impact of different anesthesia depths by target-controlled infusion of propofol and remifentanil at a fixed effect-site concentration ratio on the incidence of early postoperative neurocognitive complications in older patients undergoing noncardiac surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Light anesthesia | Experimental | Anesthesia will be maintained by target-controlled infusion of propofol and remifentanil at a fix ratio; the target BIS is 50. |
|
| Deep anesthesia | Active Comparator | Anesthesia will be maintained by target-controlled infusion of propofol and remifentanil at a fix ratio; the target BIS is 35. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Light anesthesia | Drug | Anesthesia will be maintained by target-controlled infusion of propofol and remifentanil at a fixed ratio; the target BIS is 50. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of delayed neurocognitive recovery | Cognitive function is assessed with the Montreal Cognitive Assessment (MoCA; scores range from 0 to 30, with higher scores indicating better cognitove function). A decrease of 1 SD or more from baseline is defined as cognitive decline. | On day 4 or before hospital discharge after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of recovery after surgery | Quality of recovery is assessed with the 15-item Quality of Recovery scale (QoR-15; scores range from 0 to 150, with higher scores indicating better quality of recovery). | On days 1 and 3 after surgery |
| Incidence of postoperative neurocognitive disorder |
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity within 3 days after surgery | Pain intensity is assessed twice daily (8:00-10:00, 18:00-20:00) with the numeric rating scale (NRS; scores range fro 0 to 10, with 0=no pain and 10=the worst pain). | During the first 3 days after surgery |
| Subjective sleep quality within 3 days after surgery |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dong-Xin Wang, MD, PhD | Contact | 010-83575138 | wangdongxin@hotmail.com | |
| Ding Ting, MD | Contact | dingting01@bjmu.edu.cn |
| Name | Affiliation | Role |
|---|---|---|
| Dong-Xin Wang | Peking University First Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Peking University First Hospital | Beijing | Beijing Municipality | 100034 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
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|
| Deep anesthesia | Drug | Anesthesia will be maintained by target-controlled infusion of propofol and remifentanil at a fixed ratio; the target BIS is 35. |
|
|
Cognitive function is assessed with the telephone MoCA (T-MoCA; scores range from 0 to 20, with higher scores indicating better cognitove function). A decrease of 1 SD or more from baseline is defined as cognitive decline. |
| On day 30 after surgery |
Subjective sleep quality is assessed once daily (8:00-10:00) with the numeric rating scale (NRS; scores range fro 0 to 10, with 0=the best sleep and 10=the worst sleep). |
| During the first 3 nights after surgery |
| Percentage of ICU admission after surgery | Percentage of patients required ICU admission after surgery | Up to 24 hours after surgery. |
| Length of hospital stay after surgery | Length of hospital stay after surgery | Up to 30 days after surgery. |
| Incidence of postoperative complications within 30 days | Postoperative complications are defined as new-onset conditions that are deemed harmful and required therateutic intervention, i.e., class II or higher on the Clavien-Dindo classification. | Up to 30 days after surgery |
| All-caused 30-day mortality | All-cause mortality with in 30 days after surgery. | Up to 30 days after surgery |
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| ID | Term |
|---|---|
| D015742 | Propofol |
| D000077208 | Remifentanil |
| ID | Term |
|---|---|
| D010636 | Phenols |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D011422 | Propionates |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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