Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Prospective, Randomized, Controlled Trial Comparing Bispectral Index Monitoring to Electronic Alerts for Prevention of Awareness During Anesthesia in the General Population
Brief Summary: Awareness during anesthesia is a problem receiving increased attention by patients, clinicians, and the general public. The incidence of intraoperative awareness has been reported to be between 1-2/1000 cases, but recent data suggest that this may be an overestimate. The Bispectral Index (BIS) Monitor is an electroencephalographic method of assessing depth of anesthesia that has been shown in one study to reduce the incidence of awareness during anesthesia in the high-risk population (Myles et al, 2004). In the study of Myles et al, the number needed to treat (NNT) in order to prevent one case of awareness in the high-risk population was 138, with an associated cost of approximately US$2200. Since the NNT and the associated cost of treatment would be much higher in the general population, the efficacy of the BIS monitor in preventing awareness in all anesthetized patients needs to be clearly established. Furthermore, recent data suggest that the BIS may not be useful in the high-risk population. The investigators propose a prospective, randomized, controlled trial comparing the BIS monitor to electronic alerts based on non-electroencephalographic gauges of anesthetic depth.


Options:
A: Inclusion Criteria:

* Elderly patient (≥ 75 years)
* Patient with planned hip fracture surgery within 48 hours after the hip fracture
* Patient willing and able to complete the requirements of this study including the signature of the written informed consent

Exclusion Criteria:

* Patient suffering from multiple fractures, pelvic fractures proximal, pathological fractures, femur fractures (i.e., fractures of the middle or distal femur)
* Disabling neuropsychiatric disorders (severe dementia, Alzheimer's disease, schizophrenia, depression)
* Brain trauma within 12 months prior to selection, history of stroke with residuals
* Patient suffering from delirium (CAM diagnosis) at selection
* Patient who cannot complete the pre-operative mental tests (CAM and/or MMSE) of this clinical trial
* Patient with Mini-Mental State Examination (MMSE) score \< 24 at selection
* Patient known to susceptible to malignant hyperthermia
* Patient with elevated intra-cranial pressure
* Patient with a risk of high oxygen demand
* Patient with recent or ongoing myocardial infarction / damage
* Patient with severe cardiac failure, or patient with severe impaired left ventricular systolic function
* Patient with known severe lung and/or airway disease, or severe chronic respiratory insufficiency, or a sustained homecare oxygen therapy
* Contra-indication (serious illness or medical conditions) for general anaesthesia
* Known allergy or hypersensitivity to any drugs administered during this clinical trial
* Previous participation in this clinical trial
* Participation in another clinical trial within 4 weeks prior to selection
* History of alcohol or drug abuse or psychiatric disorders which would impair the understanding of the necessary information or render medically or legally unable to give written informed consent
B: Inclusion Criteria:

* is 65 years of age or older at admission;
* has surgical treatment of a traumatic hip fracture;
* has participating surgeon;
* has Mini-Mental Status Exam score of 15 or higher;
* able to read/write/speak/hear/understand English;
* gives informed consent;
* receives spinal anesthesia

Exclusion Criteria:

* receives general anesthesia;
* does not write/write/speak/hear/understand English;
* has severe chronic obstructive pulmonary disease (COPD);
* has severe congestive heart failure (CHF);
* has Mini-Mental Status Exam score less than 15;
* declines to give informed consent;
* age less than 65 years at admission;
* attending surgeon does not participate in study
C: Inclusion Criteria:

* 18 years or older
* Positive CAM-ICU

Exclusion Criteria:

* Known allergy to rivastigmine
* Unable to receive enteric medication
* Pregnant or lactating
* Renal replacement therapy
* Hepatic encephalopathy
* Second or third degree atrioventricular block
* Uncertainty about diagnosis delirium and no confirmation by neurologist, psychiatrist or geriatrician
* Parkinson's disease.
* Lewy body dementia.
* ECG QT interval above 500 msec.
* No informed consent
D: Inclusion Criteria:

* At least 18 years of age, English-speaking, available for follow-up interview at one month.

Exclusion Criteria:

* Pre-existing neurologic or neuropsychiatric condition, surgical manipulation around forehead, not available for follow-up interview.

Answer: D