To Study the Effect of Sevoflurane and Propofol V Sevoflurane and Dexmedetomidine on Postoperative Cognitive Dysfunction
Condition: Postoperative Cognitive Dysfunction
MeSH terms: Postoperative Cognitive Complications; Cognitive Dysfunction
Study type: Interventional

Summary: 
      Postoperative Cognitive Dysfunction (POCD), is a subtle decline in cognitive function
      characterized by impairment of memory and reduced ability to concentrate in elderly patients
      exposed to general anaesthesia. This prospective study aims to compare incidence and severity
      of POCD in two groups of patients. Group P receiving Intravenous Propofol and Inhalational
      anesthetic Sevoflurane. Group D receiving Intravenous Dexmedetomidine and Inhalational
      anesthetic Sevoflurane, Neuropsychological Test will be performed 24 hours before surgery and
      on postoperative day 3 and day 7.
    

Detailed description: 
      The adult patients posted for major surgery under general anesthesia will be included in the
      study, patients will be allotted randomly to either Group P (Propofol) or Group D
      (Dexmedetomidine). In the Operation Room (OR) monitoring Electrocardiography (ECG), Pulse
      Oximetry (SPO2), Noninvasive Blood Pressure (NIBP), End tidal Carbon di oxide (ETCO2) and
      Bispectral Index (BIS) Covidien, will be attached to all patients. In both groups Anesthesia
      will be induced with Fentanyl 1mcg /kg-1, Morphine 0.1mg/kg-1, Propofol 1-1.5mg /kg1- and
      neuromuscular blocking agent Atracurium 0.5 mg/kg-1. Oral Cuffed Endotracheal Tube (ETT) will
      be placed in the trachea. Anaesthesia will be maintained controlled ventilation ,
      intermittent fentanyl boluses 20 mcg and in Group P with medicated Air/Oxygen (O2) with
      Fractional Inspired Oxygen (FiO2 50%), Sevoflurane and Propofol Infusion to maintain BIS
      between 40-60. In Group D anesthesia will be maintained with Medicated Air/Oxygen (FiO2 50%),
      Sevoflurane and Dexmedetomidine infusion to maintain BIS between 40-60. Intraoperatively
      monitoring of vitals, BIS numerical value, Minimum Alveolar Concentration (MAC) Value for
      Sevoflurane, Expired concentration of Sevoflurane and rate of infusion of
      Propofol/Dexmedetomidine will be noted every 30 minutes. Intraoperative decrease in Mean
      Arterial Pressure (MAP) < 60 mmHg, Heart rate (HR) < 50, SPO2 < 90 % will also be noted. At
      the end of surgery total dosage of Propofol/Dexmedetomidine and total amount of Sevoflurane
      consumed will be calculated. At the end of surgery neuromuscular blockade will be reversed.
      Total Duration of anesthesia will be noted. On emergence from anesthesia any episode of acute
      delirium will be recorded. Time from end of anesthesia to eye opening will be noted in both
      the groups. Neuropsychological Test consisting of Letter Digit Substitution Test, Trail
      Making Test Part A, Part B, Stroop Colour Word Test, Visual Verbal Learning Test will be
      performed 24 hours prior to surgery in the preanesthesia clinic and on postoperative day 3
      and day 7.
    

Intervention name(s): Maintainance of anesthesia with Intravenous Propofol infusion; Maintainance of anesthesia with Intravenous Dexmedetomidine
Intervention type(s): Drug; Drug
Intervention description(s): The dosage of Intravenous Propofol will be titrated to maintain BIS Values between 40 -60.; The dosage of Intravenous Dexmedetomidine will be titrated to maintain BIS Values between 40 -60.
Intervention MeSH terms: Dexmedetomidine; Anesthetics; Propofol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Diagnostic
Keywords: POCD; Elderly