Decreasing the Incidence of Delirium After Cardiac Surgery
- Conditions
- C.Surgical Procedure; CardiacDelirium
- Interventions
- Registration Number
- NCT02119806
- Lead Sponsor
- University of California, Los Angeles
- Brief Summary
In critically ill surgical patients, delirium (confusion and disorientation) is extremely common and is associated with longer hospital length of stay, mortality, cost, and long term cognitive impairment. The goal of the study is to establish whether benzodiazepines (a sedative, anti-anxiety drug) should be used as part of standard of care or be eliminated by comparing the chances of delirium in cardiac surgery patients between two groups: a group that receives benzodiazepines during surgery versus a group that does not receive benzodiazepines during surgery. Benzodiazepines have historically been used in cardiac anesthesia to decrease the risk of anesthesia awareness. The current standard of care is to keep the patient on inhaled anesthesia throughout the surgery which eliminates the need for intraoperative use of benzodiazepines. Benzodiazepines are still used based on practitioner preference. Findings of this study will allow all anesthesiologists to make more informed decisions about what level of care our patients need.
- Detailed Description
In critically ill surgical patients, delirium is extremely common and is associated with longer hospital length of stay, mortality, cost, and long term cognitive impairment. Benzodiazepine usage is common in anesthetic practice, and ICU literature demonstrates that limiting post-operative benzodiazepines decreases the incidence of delirium. However, the avoidance of preoperative and intraoperative benzodiazepines during cardiac surgery has not been studied in terms of its effect on delirium. The goal of the study is establish whether benzodiazepines should be used as part of standard of care or be eliminated by comparing the incidence of delirium in cardiac surgical patients when randomized to a group that receives benzodiazepines versus a group that does not receive benzodiazepines.
Potential subjects will be identified and recruited the day before surgery by primary investigators. Patients undergoing coronary artery bypass grafting or single valve procedures that consent to participate will be enrolled in the study. These patients may be consented during the pre-operative period. Patients will be informed that whether they enroll in the study or not, they will be receiving standard clinical care. Only subjects meeting all inclusion criteria and requirements for continuation in the study will be consented.
Patient will be randomized by age (age is a predictor of delirium) to 3 groups:
* \>80 years of age;
* 70-80 years of age;
* \< 70 years of age.
Within these 3 groups, patients will be randomized to receive benzodiazepines during cardiac surgery or not. The anesthesiologist in the operating room will not be blinded to the group; however, the intensive care physician evaluating for delirium will be blinded to the treatment groups.
Benzodiazepine group:
1. Premedication 0.02mg/kg-0.1mg/kg of midazolam;
2. Maintenance 0.8 minimum alveolar concentration of inhaled anesthetic (MAC) and 10-30mcg/kg of fentanyl;
3. Postoperative 10-100mcg/kg/min of propofol
Non-benzodiazepine group:
1. Premedication 0-50mg of propofol and/or 0-250mcg of fentanyl;
2. Maintenance 0.8 minimum alveolar concentration of inhaled anesthetic (MAC) and 10-30mcg/kg of fentanyl;
3. Postoperative 10-100mcg/kg/min of propofol
Delirium can now be reliably diagnosed by non-psychiatrists in critically ill patients in less than 2 minutes through the use of validated monitoring instruments such as the Confusion Assessment Method for the ICU (CAM-ICU).
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Adult patients' undergoing coronary artery bypass grafting or single valve procedures.
- Patients who have baseline cognitive dysfunction,
- Patients with hearing problems,
- Patients currently on benzodiazepines
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Non-benzodiazepine group Propofol 1. Premedication 0-50mg of propofol and/or 0-250mcg of fentanyl; 2. Maintenance 0.8 minimum alveolar concentration of inhaled anesthetic (MAC) and 10-30mcg/kg of fentanyl; 3. Postoperative 10-100mcg/kg/min of propofol Benzodiazepine group Fentanyl 1. Premedication 0.02mg/kg-0.1mg/kg of Benzodiazepine ; 2. Maintenance 0.8 minimum alveolar concentration of inhaled anesthetic (MAC) and 10-30mcg/kg of fentanyl; 3. Postoperative 10-100mcg/kg/min of propofol Benzodiazepine group Propofol 1. Premedication 0.02mg/kg-0.1mg/kg of Benzodiazepine ; 2. Maintenance 0.8 minimum alveolar concentration of inhaled anesthetic (MAC) and 10-30mcg/kg of fentanyl; 3. Postoperative 10-100mcg/kg/min of propofol Non-benzodiazepine group Fentanyl 1. Premedication 0-50mg of propofol and/or 0-250mcg of fentanyl; 2. Maintenance 0.8 minimum alveolar concentration of inhaled anesthetic (MAC) and 10-30mcg/kg of fentanyl; 3. Postoperative 10-100mcg/kg/min of propofol Benzodiazepine group Benzodiazepine 1. Premedication 0.02mg/kg-0.1mg/kg of Benzodiazepine ; 2. Maintenance 0.8 minimum alveolar concentration of inhaled anesthetic (MAC) and 10-30mcg/kg of fentanyl; 3. Postoperative 10-100mcg/kg/min of propofol
- Primary Outcome Measures
Name Time Method Delirium less than 2 minutes Delirium can now be reliably diagnosed by non-psychiatrists in critically ill patients in less than 2 minutes through the use of validated monitoring instruments such as the Confusion Assessment Method for the ICU (CAM-ICU)
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
Ronald Reagan UCLA Medical Center, Department of Anesthesiology
🇺🇸Los Angeles, California, United States