Comparison of Postoperative Delirium in Patients Anaesthetised With Isoflurane and Desflurane During Spinal Surgery
Condition: Postoperative Delirium
MeSH terms: Delirium; Emergence Delirium
Study type: Interventional
Phase: Phase 4

Summary: 
      Postoperative delirium (POD) is a known complication of inhalational agents used to
      anaesthetise patients for surgery with potential long term implications.The incidence of
      postoperative delirium in spine surgery is 3.3% to 3.8%.The purpose of this study is to
      compare the occurrence of postoperative delirium with inhalational anaesthetics namely
      isoflurane and desflurane in spine surgery patients.
    

Detailed description: 
      The patient will be randomized to receive isoflurane or desflurane anaesthesia prior to
      surgery. All the patients involved in the study will be blinded to group allocation.
      Screening for preoperative cognitive dysfunction will be done using the mini-cog test which
      includes a three word recall test and clock drawing test.The primary outcome variable will be
      assessment of delirium at day one and day three following surgery. Post operative delirium
      will be diagnosed using the 3D- CAM(Confusion Assessment Method) which tests for four
      features with a series of questions. The features include 1) acute onset and fluctuating
      course,2) inattention,3) disorganized thinking and 4) altered level of consciousness.
      Diagnosis of delirium is made if features 1 and 2 and either 3 or 4 are present. Similarly
      the severity of postoperative delirium will be assessed on day one and day three following
      surgery. Severity of postoperative delirium will be assessed using the CAM-S(Confusion
      Assessment Method-severity)long form delirium severity score.It assesses ten features
      including 1) acute onset and fluctuating course,2)inattention,3)disorganized thinking ,
      4)altered level of consciousness, 5) disorientation, 6)memory impairment ,7)perceptual
      disturbances ,8)psychomotor agitation, 9)psychomotor retardation and 10) altered sleep-wake
      cycle. The scores range from 0 to 19.

      The demographic data of the patients,type and site of surgery will be noted. Preoperative
      hemoglobin, serum electrolytes and blood urea will be recorded. The intraoperative factors
      like duration of surgery and anaesthesia,use of intravenous fluids ,blood loss, number blood
      units transfused and opioid use will be studied at the time of surgery. The time to emergence
      and extubation following the completion of surgery will be noted.

      The postoperative factors like postoperative pain, nausea and vomiting,
      fever,hemoglobin,serum electrolytes and blood urea will be noted.

      Preoperative and postoperative pain will be assessed using the numerical rating score on a
      scale of one to ten.

      The association of various preoperative,intraoperative and postoperative factors with POD
      will be determined.
    

Intervention name(s): Isoflurane; Desflurane
Intervention type(s): Drug; Drug
Intervention MeSH terms: Desflurane; Isoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Diagnostic
Keywords: Postoperative delirium; spine surgery; isoflurane; desflurane