Postoperative Delirium Clinical Trial
Official title:
Effect of Depth of Anaesthesia on Postoperative Cognitive Decline in Patients Undergoing Coronary Artery Bypass Graft Surgery - a Prospectively Randomized Controlled Study
Post-Operative Cognitive Decline (POCD) is common after cardiac surgery and associated with
increased morbidity and mortality. The pathophysiology of POCD is only poorly understood.
Causes include hypoperfusion, microemboli and the systemic inflammatory response, which
result in a reduction of cerebral oxygen delivery.
Cerebral oxygenation can be monitored non-invasively by measuring frontal lobe oxygen
saturation (rSO2).
The bispectral index (BIS) of the electroencephalogram is widely known to measure depth of
anaesthesia, and there is a high correlation between BIS, a dimensionless calculated number
between 0 and 100, and clinical criteria of sedation. With BIS below 60 recall is extremely
low.
The investigators demonstrated recently that inappropriately high levels of anaesthesia may
be associated with poorer long-term outcomes in cognition after non-cardiac surgery (Ballard
et al. 2012). Whether optimisation of the depth of anaesthesia and cerebral oxygenation has
an effect on postoperative cognitive function in patients undergoing cardiac surgery is
unknown.
The investigators hypothesize that the incidence of POCD in elderly patients (> 65 years old)
at 6 weeks is less with mildly deep anaesthesia (BIS 50 +- 10) and optimised rSO2
(interventions when rSO2 drops below 15% of baseline reading) when compared with current
practice (BIS blinded anaesthesia, reflecting moderately to highly deep anaesthesia and
blinded rSO2 measurements).
n/a
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