Perioperative Cognitive Protection-Dexmedetomidine and Cognitive Reserve

围术期认知保护——右美托咪定与认知储备

基本信息

批准号：
7499554
负责人：
JEFFREY H SILVERSTEIN
金额：
$ 48.99万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-30 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7499554
关键词：
Absence of pain sensation Accounting Activities of Daily Living Adrenergic Agonists Agonist Analgesics Anesthesia and Analgesia Anesthesia procedures Anesthetics Appearance Area Argipressin Arousal Attention Baby Booms Behavior Brain Cardiac Surgery procedures Cerebral Ischemia Circadian Rhythms Clinical Cognitive Community Hospitals Confusion Critical Illness Data Delirium Deterioration Development Dexmedetomidine Disease Disorientation Distress Drug usage Elderly Endorphins Enrollment Epinephrine Etiology Evaluation Failure Family Follow-Up Studies Functional disorder General Anesthesia Generations Geriatric Psychiatry Goals Health Care Costs Health Expenditures Healthcare Hospitals Hour Hydrocortisone Impaired cognition Incidence Infusion procedures Length of Stay Lesion Light Measurable Measures Mediating Medical Surveillance Midazolam Minor Surgical Procedures Morbidity - disease rate Neuraxis Neurologic Neuropsychology Neurosecretory Systems Norepinephrine Operative Surgical Procedures Pain Participant Patients Performance Perioperative Pharmaceutical Preparations Pharmacology Physicians Placebos Population Postoperative Period Prevalence Principal Investigator Propofol Public Health Randomized Randomized Clinical Trials Randomized Controlled Clinical Trials Randomized Controlled Trials Rate Recovery Research Personnel Risk Risk Factors Role Saliva Sampling Score Sedation procedure Sensory Severities Sleep Standards of Weights and Measures Stress Syndrome Techniques Testing Thinking Translating Uncertainty United States Waxes Work base biological adaptation to stress clinically significant cognitive function cognitive reserve concept cost day disability experience follow-up improved indexing innovation interest medical complication mild neurocognitive impairment mortality older patient prevent programs response sedative

项目摘要

DESCRIPTION (provided by applicant): Elderly patients who undergo anesthesia and non-cardiac surgery are subject to deterioration of brain function including the development of postoperative delirium (PD) and postoperative cognitive dysfunction (POCD). These disorders cause disability, distress for both patients and their families, are associated with other medical complications and account for significant additional health care costs. We currently use relatively primative approaches to preventing and treating PD and POCD. The proposed project expands on previous work exploring PD and POCD to propose a randomized controlled trial of perioperative dexmedetomidine to prevent PD and, potentially, POCD. Seven hundred and six patients will be enrolled at seven centers representing both academic and community hospitals. Participants will undergo preoperative cognitive testing and provide saliva samples for cortisol. Patients will be randomized to either dexmedetomidine or placebo which will be started prior to surgery and continued for 24 hours postoperatively. Follow up studies will include surveillance for delirium while in the hospital and cognitive testing at 3 and 6 months following surgery. Part of the neuropsychologic evaluation will include an assessment for mild cognitive impairment(MCI). Dexmedetomidine is a drug used for sedation in critically ill patients that provides some pain relief and controls the bodies response to stress. The sedation produced by dexmedetomidine appears more similar to natural sleep than any other drug used for anesthesia and postoperative sedation. Data indicating that dexmedetomidine can prevent delirium following cardiac surgery and the developing understanding of the causes of PD and POCD suggest that dexmedetomidine will be particularly effective. The proposed project includes important efforts to further define POCD and understand the pathophysiology of these problems. The evaluation of patients for MCI represents a particularly important and challenging innovation in the study of PD and POCD. PUBLIC HEALTH: Almost eight million elderly patients had surgery in 2004. Perhaps 10% of those patients suffer from problems that can be thought of as postoperative brain failure. These problems are extremely expensive in terms of health care dollars and cause significant disability - representing the next challenge for physicians as they confront the increasing surgical burden of the baby boom generation.

描述（由申请人提供）：接受麻醉和非心脏手术的老年患者容易出现脑功能恶化，包括术后谵妄（PD）和术后认知功能障碍（POCD）。这些疾病会导致患者及其家人残疾、痛苦，并与其他医疗并发症相关，并造成大量额外医疗费用。目前我们使用相对原始的方法来预防和治疗PD和POCD。拟议的项目扩展了之前探索 PD 和 POCD 的工作，提出一项围手术期右美托咪定预防 PD 和潜在 POCD 的随机对照试验。代表学术医院和社区医院的七个中心将招募 706 名患者。参与者将接受术前认知测试并提供皮质醇唾液样本。患者将被随机分配接受右美托咪定或安慰剂治疗，并在手术前开始并持续术后 24 小时。后续研究将包括住院期间的谵妄监测以及术后 3 个月和 6 个月的认知测试。神经心理学评估的一部分将包括对轻度认知障碍（MCI）的评估。右美托咪定是一种用于危重患者镇静的药物，可以缓解一定程度的疼痛并控制身体对压力的反应。与任何其他用于麻醉和术后镇静的药物相比，右美托咪定产生的镇静作用看起来更类似于自然睡眠。数据表明右美托咪定可以预防心脏手术后的谵妄，并且对 PD 和 POCD 原因的不断了解表明右美托咪定将特别有效。拟议的项目包括进一步定义 POCD 和了解这些问题的病理生理学的重要努力。对患者 MCI 的评估代表了 PD 和 POCD 研究中特别重要且具有挑战性的创新。公共卫生：2004 年，近 800 万老年患者接受了手术。其中大约 10% 的患者患有术后脑衰竭的问题。这些问题在医疗保健费用方面极其昂贵，并导致严重残疾——这对医生来说是下一个挑战，因为他们面临着婴儿潮一代日益增加的手术负担。