The Effect of Anesthesia on Cerebral Oxygenation

Thoracic Surgery Clinical Trial

Official title:

The Effect of Different Anesthesia Techniques on Cerebral Oxygenation in Thoracic Surgery

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04760262
• Other study ID #: 2013/21
• Status: Completed
• Start date: March 1, 2017
• Est. completion date: January 20, 2020

Study information

• Verified date: February 2021
• Source: Karadeniz Technical University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

One-lung ventilation (OLV) may cause negative changes in the oxygenation of cerebral tissue which results in postoperative cognitive dysfunction. The aim of this prospective study was to compare the potential effects of TIVA and inhalation general anesthesia techniques on cerebral tissue oxygenation and postoperative cognitive functions in patients receiving one-lung ventilation in thoracic surgery

Description:

One-lung ventilation (OLV) is a commonly used technique in thoracic surgeries. In thoracic surgeries performed with OLV, there may be changes in cerebral tissue oxygenation depending on both patient position and anesthetic technique. The effect of cerebral hypoxia on postoperative cognitive functions is controversially. Despite the ISPOCD1 study in which concluded that there were no relationship between the cerebral hypoxy and postoperative cognitive dysfunction (POCD) regional cerebral oxygen saturation decrements during surgery are listed among the POCD When OLV begins, alveolar hypoxia and arteriovenous shunt of deoxygenated blood occur in the dependant lung. And then, hypoxic pulmonary vasoconstriction (HPV) in non-ventilated lung segments occurs with increased mechanical stress. This event lead to significant physiological changes in cardiac output and pulmonary and systemic pressures In OLV, the propofol-based total intravenous anesthesia (TIVA) and inhalation general anesthesia techniques are frequently used. Recent studies have shown that unlike inhalational anesthetics, propofol does not suppress HPV, indeed increases it (Inhalational anesthetic agents reduce cardiac output more than oxygen consumption, causing a decrease in mixed venous partial pressure of oxygen, which stimulates hypoxic pulmonary vasoconstriction . Studies have shown significant reductions in cerebral oxygen saturation in thoracic surgery as a result of severe oxidative stress due to prolonged OLV and hypoxemia due to decreased functional residual capacity of the ventilated lung in the lateral decubitus position Cerebral oximetry is a method used to monitor the cerebral oxygen distribution-consumption balance and regional oxygen saturation (rSO2) in a limited area of the frontal cortex by noninvasively and continuously combining arterial and venous oxygen saturation signals of near-infrared spectroscopy (NIRS), which is a technique developed in the 1970s. Thanks to this method, perioperative physiological conditions, optimal tissue oxygenation and end-organ functions can be interpreted The aim of this prospective study was to compare the potential effects of TIVA and inhalation general anesthesia techniques on cerebral tissue oxygenation and postoperative cognitive functions in patients receiving one-lung ventilation in thoracic surgery

Recruitment information / eligibility

• Status: Completed
• Enrollment: 30
• Est. completion date: January 20, 2020
• Est. primary completion date: June 15, 2019
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Patients in American Society of Anesthesiology (ASA) classification I and II
• Patients who would undergo thoracic surgery with one-lung ventilation (OLV)
• thoracic surgeries with one-lung ventilation (OLV) that will take at least 45 minutes

Exclusion Criteria:

• Patients in ASA classification III and higher
• Emergency surgery
• Patients with known allergy to drugs used in the study
• Patients in New York Heart Association classification III-IV
• severe metabolic, renal, hepatic, central nervous system diseases, alcohol or drug addiction
• multiple trauma, coagulapathy, cerebral disease, dementia, hearing impairment and imperception
• severe obesity (a body mass index (BMI) of = 35)
• patients with a peripheral oxygen saturation below 90 during one lung ventilation

Related Conditions & MeSH terms

• One-Lung Ventilation
• Postoperative Cognitive Complications
• Thoracic Surgery

Intervention

Drug:
• Sevoflurane
Sevoflurane %2-3 for general anesthesia maintenance, BIS values were arranged 40-60 until the end of operation, In case of tachycardia or hypertension the opioid dose was reduced, in case of bradycardia or hypertension the opioid dose was increased
• Propofol
BIS values were arranged 40-60 until the end of operation, In case of tachycardia or hypertension the opioid dose was reduced, in case of bradycardia or hypertension the opioid dose was increased

Locations

Country	Name	City	State
Turkey	Karadeniz Technical University	Trabzon

Sponsors (1)

Lead Sponsor	Collaborator
Karadeniz Technical University

Country where clinical trial is conducted

Turkey, 

References & Publications (5)

Aguirre JA, Märzendorfer O, Brada M, Saporito A, Borgeat A, Bühler P. Cerebral oxygenation in the beach chair position for shoulder surgery in regional anesthesia: impact on cerebral blood flow and neurobehavioral outcome. J Clin Anesth. 2016 Dec;35:456-464. doi: 10.1016/j.jclinane.2016.08.035. Epub 2016 Oct 18. — View Citation

Hood R, Budd A, Sorond FA, Hogue CW. Peri-operative neurological complications. Anaesthesia. 2018 Jan;73 Suppl 1:67-75. doi: 10.1111/anae.14142. Review. — View Citation

Kazan R, Bracco D, Hemmerling TM. Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications. Br J Anaesth. 2009 Dec;103(6):811-6. doi: 10.1093/bja/aep309. — View Citation

Mahal I, Davie SN, Grocott HP. Cerebral oximetry and thoracic surgery. Curr Opin Anaesthesiol. 2014 Feb;27(1):21-7. doi: 10.1097/ACO.0000000000000027. Review. — View Citation

Nakayama M, Murray PA. Ketamine preserves and propofol potentiates hypoxic pulmonary vasoconstriction compared with the conscious state in chronically instrumented dogs. Anesthesiology. 1999 Sep;91(3):760-71. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Near Infrared Spectroscopy	Cerebral oxygen saturation as measured by Near Infrared Spectroscopy	Duration of surgery
Primary	Mini mental state examination (MMSE)	Mini mental state examination (MMSE) to evaluate patients' cognitive functions	3 to 24 hours postoperative period
Secondary	mean arterial pressure	The effect of anesthetics on mean arterial pressure	Duration of surgery
Secondary	heart rate	The effect of anesthetics on heart rate	Duration of surgery
Secondary	bispectral index	The effects of sevoflurane and desflurane on bispectral index	Duration of surgery