Perioperative Multimodal General AnesTHesia Focusing on Specific CNS Targets in Patients Undergoing carDiac surgERies — PATHFINDERII  

Pain Clinical Trial

Official title: Perioperative Multimodal General AnesTHesia Focusing on Specific CNS Targets in Patients Undergoing carDiac surgERies - the PATHFINDER II Study

Status Recruiting

Clinical Trial Summary

In the PATHFINDER 2 trial, the study investigators will test the intraoperative EEG-guided multimodal general anesthesia (MMGA) management strategy in combination with a postoperative protocolized analgesic approach to:

1. reduce the incidence of perioperative neurocognitive dysfunction in cardiac surgical patients

2. ensure hemodynamic stability and decrease use of vasopressors in the operating rooms

3. reduce pain and opioid consumption postoperatively

Clinical Trial Description

The investigators propose to randomize (1:1) 70 patients undergoing cardiac surgery to the perioperative EEG-guided MMGA bundle (described in full below) or standard-of-care management based primarily on the use of sevoflurane for unconsciousness and intermittent doses of fentanyl and hydromorphone for antinociception.

The team will test the intraoperative EEG-guided MMGA management strategy in combination with a postoperative protocolized analgesic approach to reduce the postoperative increase of surgical and delirium markers, reduce intraoperative abnormalities in brain health monitoring, ensure hemodynamic stability and decreased use of vasopressors in the operating rooms and reduce pain and opioid consumption postoperatively. The team will also investigate whether EEG-guided MMGA strategy reduces the incidence of perioperative neurocognitive dysfunction in cardiac surgical patients. This approach will further individualize care and minimize the use of intraoperative vasopressor-inotropic dose, dose of anesthetic medications, and postoperative opioids given to each patient potentially preventing hemodynamic complications and post-operative cognitive dysfunction after surgery. ;

Related Conditions & MeSH terms

• Cognitive Dysfunction
• Emergence Delirium
• Hemodynamic Instability
• Neurocognitive Dysfunction
• Pain
• Postoperative Delirium

• NCT number: NCT05279898
• Study type: Interventional
• Source: Beth Israel Deaconess Medical Center
• Contact: Balachundhar Subramaniam, MD,MPH,FASA
• Phone: 617-667-2721
• Email: sadhgurucenter_research@bidmc.harvard.edu
• Status: Recruiting
• Phase: N/A
• Start date: February 28, 2023
• Completion date: November 2024