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Geriatric Patient Care ImprovementNCT06844279

The Effects of Anesthesia Depth Monitoring on Postoperative Recovery and Cognitive Functions in the Geriatric Patient Population

A study testing Processed Electroencephalogram (BIS Index) and Processed Electroencephalogram (DSA Mode) in people with Geriatric Patient Care Improvement and Postoperative Delirium (POD), run by Aslıhan Güleç at 1 site in Turkey (Türkiye).

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study will be conducted on patients aged 65 and older scheduled for surgery due to lumbar or cervical disc herniation. General anesthesia is routinely used for these types of surgeries in the hospital. In patients receiving general anesthesia, anesthesia depth monitoring is performed. Read more about this study

Who is it for?
Ages 65 years and older
What is being tested?
Processed Electroencephalogram (BIS Index) and Processed Electroencephalogram (DSA Mode)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
75 participants
Where
1 siteTurkey (Türkiye)
Study dates
10 Jan 2025to Apr 2025
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 65 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • 65 years and older
  • Elective spinal surgeries
  • ASA status I-III

Who cannot join

  • Emergent surgeries
  • ASA status IV-V
  • Prediagnosed delirium and or dementia
  • Inability to give consent

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Aslihan Gulec Kilic, MD contact

+905072709000

aslihangulec@gazi.edu.tr

Gozde Inan, Associate Professor contact

+905358105620

inangozde@yahoo.com

Turkey (Türkiye)1 site, 1 recruiting
  • Gazi University School of Medicine

    Ankara, 06560

    Aslihan Gulec Kilic, MD, +905072709000, aslihangulec@gazi.edu.tr

    Gozde Inan, Associate Professor, +905358105620, inangozde@yahoo.com

    Recruiting

Other trials in Turkey (Türkiye)

About this study

Official title: Geriatrik Hasta Grubunda Anestezi Derinliği Monitörizasyonlarının Postoperatif Derlenme ve Bilişsel Fonksiyonlara Etkileri

This study will be conducted on patients aged 65 and older scheduled for surgery due to lumbar or cervical disc herniation. General anesthesia is routinely used for these types of surgeries in the hospital. In patients receiving general anesthesia, anesthesia depth monitoring is performed.

As part of the study, a preoperative anesthesia evaluation will be conducted, which will include age, weight, height, comorbidities, regularly used medications, previous surgical or anesthesia experiences, nutritional habits, mental status, and daily activity levels.

Read more

On the day of surgery, upon arrival in the operating room, the following will be measured and recorded:

  • Blood pressure using a non-invasive blood pressure monitor
  • Heart rate and rhythm via electrocardiogram (ECG)
  • Blood oxygen level with a pulse oximeter
  • Anesthesia depth using a forehead-applied sensor

All monitoring procedures are non-invasive and painless. Following the placement of these monitoring devices and initial measurements, anesthesia induction and surgery will commence. Throughout surgery, blood pressure, heart rate, and brain activity will be continuously recorded. After the surgical procedure, anesthesia emergence and mental status will be assessed. Preoperative evaluation data and intraoperative recordings will be used solely for research purposes, with patient identity information remaining confidential.

Read the detailed description

Perioperative cognitive decline and delirium occur more frequently in the geriatric population undergoing surgery. International guidelines recommend monitoring anesthesia depth to reduce the risk of postoperative cognitive dysfunction. Anesthesia depth is commonly measured using non-invasive electroencephalography (EEG)-based methods, such as the Bispectral Index (BIS).

Previous studies have predominantly utilized processed EEG monitors that generate numerical values for tracking anesthesia depth. However, in this study, anesthesia depth will be monitored using both the standard numerical BIS index and the Density Spectral Array (DSA) mode, an advanced feature of the BIS device. To date, no studies have simultaneously examined BIS and DSA modes in relation to cognitive function and the recovery process.

The use of advanced monitoring techniques may serve as a valuable resource for future research, particularly in optimizing anesthetic management for geriatric patients with reduced cognitive reserve. This study aims to evaluate the effects of different intraoperative anesthesia depth monitoring approaches, including hemodynamic monitoring, numerical BIS values, and DSA functions. The primary objective is to determine the optimal anesthesia monitoring strategy that minimizes intraoperative hypotension, burst suppression, and postoperative delirium.

Being tested
Control Group: Standard Hemodynamic Monitoring, Processed Electroencephalogram (BIS Index), Processed Electroencephalogram (DSA Mode)
Keywords
anaesthesia depth monitoring, geriatric, density spectral array, bispectral index, burst supression, postoperative delirium
Medical subject headings
Emergence Delirium

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Control Group: Standard Hemodynamic MonitoringOther

    Anesthesia depth monitoring based on hemodynamic values without additional processed EEG guidance.

  • Processed Electroencephalogram (BIS Index)Device

    Anaesthesia depth monitoring according to numeric BIS index values.

  • Processed Electroencephalogram (DSA Mode)Device

    Anaesthesia depth monitoring according to density spectral array functions

Study groups in NCT06844279
Study groupRoleWhat they receive
Hemodynamic-Guided GroupActive comparatorAnesthesia depth monitoring will be managed according to hemodynamic parameters, primarily avoiding hypotension.
Receives: Other: Control Group: Standard Hemodynamic Monitoring
BIS-Guided GroupActive comparatorAnaesthesia depth monitoring according to numeric BIS index values
Receives: Device: Processed Electroencephalogram (BIS Index)
DSA-Guided GroupActive comparatorAnesthesia depth monitoring using the Density Spectral Array (DSA) function of the BIS monitor.
Receives: Device: Processed Electroencephalogram (DSA Mode)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Ratio of Burst Suppression

    The burst suppression ratio (BSR) will be calculated as the percentage of total anesthesia time spent in burst suppression, as measured by processed electroencephalography (EEG). A higher BSR has been associated with worse postoperative cognitive outcomes.

    Measured: Intraoperative (continuously recorded from anesthesia induction to emergence)

  2. Time of Burst Suppression

    Anesthesia time spent in burst suppression (BS), as measured by processed electroencephalography (EEG). A higher BS time has been associated with worse postoperative cognitive outcomes.

    Measured: Intraoperative (continuously recorded from anesthesia induction to emergence)

  3. Intraoperative Hypotension Incidence

    Intraoperative hypotension will be measured in 5-minute intervals. Hypotension is a mean arterial pressure (MAP) below 60 mmHg. The episodes of hypotension at any point during surgery will be recorded.

    Measured: Intraoperative (assessed continuously throughout surgery)

  4. Alpha Band Preservation or Loss

    Alpha band activity (8-12 Hz) in the frontal lobe will be evaluated to determine whether it is preserved or lost during general anesthesia. Alpha band preservation is associated with optimal anesthesia depth and cognitive function preservation, while loss of alpha band activity is linked to increased postoperative cognitive impairment.

    Measured: Intraoperative (measured continuously from anesthesia induction to emergence)

Secondary outcomes (5)
  1. Incidence of Postoperative Delirium Assessed via CAM Scale

    Postoperative delirium will be assessed using the Confusion Assessment Method (CAM) tool. The number of participants meeting the criteria for delirium within the first 48 hours postoperatively will be recorded.

    Measured: Postoperative (assessed at 6, 24, and 48 hours after surgery)

  2. Total Intraoperative Propofol Consumption

    The total dose of propofol administered intraoperatively will be recorded. Data will be reported as mg/kg.

    Measured: Intraoperative

  3. Total Intraoperative Sevoflurane Consumption

    The total dose of Sevoflurane administered intraoperatively will be recorded. Data will be reported as ml.

    Measured: Intraoperative

  4. Total Intraoperative Remifentanil Consumption

    The total dose of Remifentanil administered intraoperatively will be recorded. Data will be reported as mcg/kg.

    Measured: Intraoperative

  5. Total Intraoperative Vasopressor Consumption

    The total dose of vasopressors (noradrenaline, adrenaline, dopamine) administered intraoperatively will be recorded. Data will be reported as mcg/kg.

    Measured: Intraoperative

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Feb 2025
  2. Study start10 Jan 2025
  3. Primary completion15 Mar 2025 (estimated)
  4. Study completionApr 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Group 1: Anaesthesia depth monitoring according to hemodynamic values Group 2: Anaesthesia depth monitoring according to numeric BIS values (numbers between 40 to 60 is aimed) Group 3: Anaesthesia depth monitoring according to DSA function (avoiding obvious burst supression and keeping alpha band in high frequency)
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
75 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06844279
Sponsor's protocol ID
Gazi-2024 -1816
Status last verified
Feb 2025
First submitted
9 Feb 2025
Last updated
28 Feb 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: All IPD that underlie results in the publication

Publications

  • Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures. Anesthesiology. 2015 Oct;123(4):937-60. doi: 10.1097/ALN.0000000000000841.

    PubMed 26275092
  • Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Audisio R, Borozdina A, Cherubini A, Jones C, Kehlet H, MacLullich A, Radtke F, Riese F, Slooter AJ, Veyckemans F, Kramer S, Neuner B, Weiss B, Spies CD. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017 Apr;34(4):192-214. doi: 10.1097/EJA.0000000000000594.

    PubMed 28187050
  • Wildes TS, Mickle AM, Ben Abdallah A, Maybrier HR, Oberhaus J, Budelier TP, Kronzer A, McKinnon SL, Park D, Torres BA, Graetz TJ, Emmert DA, Palanca BJ, Goswami S, Jordan K, Lin N, Fritz BA, Stevens TW, Jacobsohn E, Schmitt EM, Inouye SK, Stark S, Lenze EJ, Avidan MS; ENGAGES Research Group. Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. JAMA. 2019 Feb 5;321(5):473-483. doi: 10.1001/jama.2018.22005.

    PubMed 30721296
  • Chen YC, Hung IY, Hung KC, Chang YJ, Chu CC, Chen JY, Ho CH, Yu CH. Incidence change of postoperative delirium after implementation of processed electroencephalography monitoring during surgery: a retrospective evaluation study. BMC Anesthesiol. 2023 Oct 4;23(1):330. doi: 10.1186/s12871-023-02293-9.

    PubMed 37794315
  • Shao YR, Kahali P, Houle TT, Deng H, Colvin C, Dickerson BC, Brown EN, Purdon PL. Low Frontal Alpha Power Is Associated With the Propensity for Burst Suppression: An Electroencephalogram Phenotype for a "Vulnerable Brain". Anesth Analg. 2020 Nov;131(5):1529-1539. doi: 10.1213/ANE.0000000000004781.

    PubMed 33079876
  • Fritz BA, Kalarickal PL, Maybrier HR, Muench MR, Dearth D, Chen Y, Escallier KE, Ben Abdallah A, Lin N, Avidan MS. Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium. Anesth Analg. 2016 Jan;122(1):234-42. doi: 10.1213/ANE.0000000000000989.

    PubMed 26418126
  • Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008 Jan;108(1):18-30. doi: 10.1097/01.anes.0000296071.19434.1e.

    PubMed 18156878

Questions about this trial

What is this clinical trial studying?

A study testing Processed Electroencephalogram (BIS Index) and Processed Electroencephalogram (DSA Mode) in people with Geriatric Patient Care Improvement and Postoperative Delirium (POD), run by Aslıhan Güleç at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 28 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Aslihan Gulec Kilic, MD (+905072709000, aslihangulec@gazi.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Ratio of Burst Suppression (time frame: Intraoperative (continuously recorded from anesthesia induction to emergence)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06844279, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2025.

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