International Substudy Enigma2 on Postoperative Cognitive Disorders
Maneno muhimu
Kikemikali
Maelezo
Numerous studies questioned the routine use of nitrous oxide (N2O), the oldest anaesthetic agent used since the development of anaesthesia care. Despite its wide use, there is sufficient doubt as to the risk-benefit profile.
There is strong evidence that N2O is a major risk factor for postoperative nausea and vomiting. It is clear that (even) brief exposure to N2O impairs methionine synthetase, an enzyme required for DNA production, red and white blood cell formation. Tissue hypoxia may be more common. These adverse effects are enhanced in "sick" patients (ie. those at highest risk, with increased hospital length of stay and healthcare expenditure), and will be more likely in longer surgery. At the same time, observational studies and subgroup analysis of published trials suggest that N2O may have beneficial effects in preventing pain and postoperative cognitive disorders
Outcome trial data on postoperative cognitive disorders are lacking in this area for an anaesthetic gas used in more than 90% of all surgery around the world. The enigma2 substudy as a nested study of the large Enigma2 randomised controlled trial aims at answering this question.
The investigators aim at recruiting 420 patients in 2 of the 25 centres participating to the Enigma 2 trials, who are undergoing major surgery.
Tarehe
| Imethibitishwa Mwisho: | 07/31/2018 |
| Iliyowasilishwa Kwanza: | 06/25/2015 |
| Uandikishaji uliokadiriwa Uliwasilishwa: | 06/30/2015 |
| Iliyotumwa Kwanza: | 07/01/2015 |
| Sasisho la Mwisho Liliwasilishwa: | 08/01/2018 |
| Sasisho la Mwisho Lilichapishwa: | 08/05/2018 |
| Tarehe halisi ya kuanza kwa masomo: | 05/31/2013 |
| Tarehe ya Kukamilisha Msingi iliyokadiriwa: | 11/30/2019 |
| Tarehe ya Kukamilisha Utafiti: | 05/31/2020 |
Hali au ugonjwa
Uingiliaji / matibabu
Drug: Nitrous Oxide
Other: Air/Oxygen (placebo)
Awamu
Vikundi vya Arm
| Mkono | Uingiliaji / matibabu |
|---|---|
| Active Comparator: Nitrous Oxide Receives a mixture of 70% Nitrous Oxide in 30% Oxygen | Drug: Nitrous Oxide Administration of a concentration of 70% Nitrous Oxide with 30% Oxygen in the anaesthetic gas mixture |
| Placebo Comparator: Air/Oxygen (placebo) Receives a mixture of 70% Air in 30% Oxygen | Other: Air/Oxygen (placebo) Administration of a concentration of 70% Air with 30% Oxygen in the anaesthetic gas mixture |
Vigezo vya Kustahiki
| Zama zinazostahiki Kujifunza | 18 Years Kwa 18 Years |
| Jinsia Inastahiki Kujifunza | All |
| Hupokea Wajitolea wa Afya | Ndio |
| Vigezo | Inclusion Criteria: Adult males and females aged ≥ 45 years, undergoing noncardiac surgery and general anaesthesia that exceeds two hours. At increased risk of cardiac events, defined as any of: - history of coronary artery disease (angina, MI, Coronary revascularisation-Coronary Artery Bypass Graft (CABG) and Percutaneous Transluminal Coronary Angiography ( PTCA)-, positive stress testing, angiography/other imaging, Q waves on ECG) - heart failure - cerebrovascular disease due to atherothrombotic disease - aortic or peripheral vascular disease OR three or more of the following risk factors: age ≥70 years, history of heart failure, diabetes (medicated), hypertension (medicated), preoperative serum creatinine >175 mmol/L, cholesterol ≥6.2 mmol/L, history of a transient ischemic attack (TIA), Exclusion Criteria: 1. Dementia (MMS test≤24) 2. Parkinson Disease 3. Patients taking regularly (>2 weeks) tricyclic antidepressants or neuroleptics 4. Patients suffering from Alcohol Dependency (WHO CRITERIA ) 5. Patients suffering from severe hypoacusis or visual loss or any other reason hindering the CANTAB battery testing process 6. Patients with untreated deficit in Vitamin B6, B12 and folic acid 7. Patients with marked impairment of gas-exchange requiring Fi02> 0.5 intraoperatively 8. Patients with specific circumstances where N2O is contraindicated (eg. volvulus, pulmonary hypertension, raised intracranial pressure) or the use of supplemental oxygen is planned (eg. colorectal surgery) 9. N2O unavailable |
Matokeo
Hatua za Matokeo ya Msingi
1. Memory, Executive function, Attention and psychomotor speed using CANTAB Cognitive testing battery [Baseline before surgery]
2. Memory, Executive function, Attention and psychomotor speed using CANTAB Cognitive testing battery at 7days following surgery [First assessment (7 days)]
3. Memory, Executive function, Attention and psychomotor speed using CANTAB Cognitive testing battery at 3 months following surgery [Second assessment (3 months)]
Hatua za Matokeo ya Sekondari
1. ICU stay [up to a maximum of 3 months]
2. Hospital stay [up to a maximum of 3 months]
3. Quality of life [3 months]
