Optimizing Anesthesia to Prevent Postoperative Cognitive and Functional Decline in Older Adults: A Randomized Controlled Trial
Oregon Health and Science University
Summary
Traditionally, general anesthesia is maintained with inhalational anesthesia (GAS), but there is a gap in knowledge regarding whether intravenous anesthesia (IV) can prevent deleterious postoperative outcomes in the geriatric surgical population. The goal of this clinical trial is to determine whether intravenous anesthesia (IV) leads to a decreased incidence of postoperative delirium (POD), postoperative cognitive dysfunction (POCD), and functional decline, and improved patient-reported outcomes (PROs) in older adults undergoing non-cardiac surgery when compared to the standard inhalational anesthesia (GAS). This single-center, 1:1 randomized, double-blind (patient \& outcome assessor) clinical trial will compare inhalational vs. intravenous anesthesia on POD, POCD, functional status, patient-reported outcomes (PROs), and blood-based biomarkers in older patients undergoing elective, inpatient, non-cardiac surgery. Upon enrollment, 260 women and men ≥ 70 years undergoing elective noncardiac surgery under general anesthesia will be randomized to 2 groups: TIVA or GAS.
Description
Aim 1: Determine the effects of intravenous vs. inhalational anesthesia on incidence of postoperative delirium and postoperative cognitive dysfunction in older adults undergoing non-cardiac surgery. Hypothesis: Intravenous anesthesia is associated with a lower incidence of POD and POCD compared to inhalational anesthesia. Primary outcomes: Incidence of postoperative delirium and postoperative cognitive dysfunction Secondary outcomes: delirium severity, delirium duration Aim 2: Determine the effects of intravenous vs. inhalational anesthesia on incidence of postoperative functional decline an…
Eligibility
- Age range
- 70–110 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion criteria: * Men and women ≥ 70 years * Sufficient vision and hearing to complete all tests * Proficient in spoken and written English * Scheduled for elective, inpatient, noncardiac surgery, expected to last at least 120 minutes requiring general anesthesia Exclusion criteria: * Urgent or emergent surgery * Diagnosed dementia (or MoCA\<19) * History of Parkinson's disease, major psychiatric disease (Schizophrenia), or severe traumatic brain injury * Ongoing alcohol or substance abuse (per DSM V criteria) * Allergy to propofol or sevoflurane * Personal or family history of malignan…
Interventions
- DrugSevoflurane
Inhalational maintenance of anesthesia group using sevoflurane
- DrugPropofol
Intravenous maintenance of anesthesia group using propofol
Location
- Oregon Health & Science UniversityPortland, Oregon