The Application of Anesthesia Depth Monitoring on Post-operative Cognitive Dysfunction for Patients With Hydrocephalus Receiving Ventricular-peritoneal Shunt Surgery and Associated Change in CSF Metabolomics and Glymphatic Function.
Overview
- Phase
- N/A
- Intervention
- Dexmedetomidine
- Conditions
- The Association of Postoperative Cognitive Dysfunction With Glymphatic Function and Neuroinflammation
- Sponsor
- Chang Gung Memorial Hospital
- Enrollment
- 48
- Locations
- 1
- Primary Endpoint
- NMR amd LC-MS CSF and plasma metabolomics
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
In this randomized control study, the investigators intended to evaluate the influence of different anesthetics on postoperative cognitive dysfunction, neuroinflammation, CSF metabolomics, and glymphatic function in patients with normal pressure hydrocephalus for VP shunt surgery. The investigators assume that the use of dexmedetomidine infusion and proper anesthsia depth during general anesthesia, in addition to multi-model analgesia, might be helpful to enhance glymphatic function, reduce neuroinflammation, and decrease postoperative cognitive dysfunction.
Detailed Description
In this prospective randomized controlled study, 48 patients with communicating hydrocephalus will be enrolled in the study and these patients will be divided into 3 groups in which intervention group received anesthesia depth monitoring (BIS group and DEX group) and dexmedetomidine infusion (DEX group), while the controlled group received usual anesthesia care without dexmedetomidine during VP shunt surgery. The participant's intraoperative CSF and plasma samples will be collected for biochemical analysis and metabolomic analysis. The investigators will use two analytical metabolomic platforms, including nuclear magnetic resonance (NMR) and liquid chromatography-mass spectrometry (LC-MS), to execute quantitative metabolomics on human CSF and plasma samples. These metabolomic data will be compared with previous established human aging CSF Metabolome Database. After VP shunt surgery, these patient's glymphatic function will be evaluated with 3T functional MRI. The postoperative cognitive function and delirium status of these patients will be evaluated for the following 3 days using MMSE score, Montreal Cognitive Assessment, and CAM-ICU score. During analysis, the pre-operative metabolomic signature of patients with postoperative cognitive dysfunction(POCD) will be compared with patients without POCD to profile the metabolomics of POCD. Besides, the investigators could examine the correlation of glymphatic function and POCD. By comparing the CSF metabolomic change in these three groups, the investigators could evaluate the the efficacy of anesthesia depth monitoring and dexmedetomidine to reduce POCD development during VP shunt surgery. The result of this study might be able to explain the brain pathophysiology of POCD, the role of glymphatic function in POCD, metabolomic signature of POCD, and establish a better anesthesia regimen to reduce the development of POCD.
Investigators
Eligibility Criteria
Inclusion Criteria
- •patients with communicating hydrocephalus for elective VP shunt surgery under general anesthesia
- •age\> 60 y/o
- •conscious clear
- •fluency in Chinese
- •anticipated hospital stay ≥ 3 days after surgery
Exclusion Criteria
- •unstable preoperative condition (unstable angina, CHF, asthma attack) within 4 weeks before surgery,
- •severe hepatic dysfunction or renal failure
- •history of neuropsychological diseases such as schizophrenia, Parkinson's disease, dementia, stroke,
- •pre-op cognitive impairment,
- •preoperative delirium,
- •preoperative depression,
- •allergy to contrast medium of MRI.
Arms & Interventions
DEX group
use BIS monitoring to adjust anesthetics and give dexmedetomidine infusion.
Intervention: Dexmedetomidine
BIS group
Use BIS monitoring to adjust intraoperative anesthetics.
Intervention: anesthesia depth monitoring
DEX group
use BIS monitoring to adjust anesthetics and give dexmedetomidine infusion.
Intervention: anesthesia depth monitoring
Outcomes
Primary Outcomes
NMR amd LC-MS CSF and plasma metabolomics
Time Frame: preoperative, postoperative 2 hours, postoperative day 1
NMR and LC-MS metabolomics of CSF and plasma samples
Postoperative cognitive function
Time Frame: postoperative 2 hours, postoperative day 1, postoperative day 2, postoperative day 3
MMSE, MoCA, CAM-ICU score
Secondary Outcomes
- Glymphatic function(preoperative, postoperative day 1)
- Neuroinflammation parameters(preoperative, postoperative 2 hours, postoperative day 1)