Cognitive Functions After TIVA With Dexmedetomidine
Condition: Postoperative Confusion
MeSH terms: Confusion
Study type: Interventional
Phase: Phase 4

Summary: 
      It is important to wake up without any problem and comfortably from the general anesthesia.
      The aim of this study is to investigate the effects of addition dexmedetomidine to the
      balanced intravenous anesthesia with propofol over the cognitive functions and also it is
      considered that the addition of dexmedetomidine would reduce the use of anesthetics drugs in
      TİVA. Together with this effects, it has been considered that the disorder of the cognitive
      functions in postoperative period and the need for anesthetic drugs in postoperative period
      will be less.

      After the approval of the Ethics Committee and the patients being informed and taking
      informed consent from them 15 male 25 female totally 40 patients between the age of 20-60
      years old, who had lumbar disc hernia, under general anesthesia have been taken under the
      study. The patients have been divided into two groups by closed envelope drawing method,
      randomly. All patients cognitive functions were evaluated by MMSE (Mini Mental State
      Examination) during the premedication visit. For this study group Standardized Mini Mental
      Test Examination (SMMT-E) were used, which has quite practical usage, for the untrained
      patients, and test composed of question-answer in order to calculate the remembering, caution
      and calculation structure and the scores were recorded. All patients had received the same
      anesthesia induction with propofol infusion (started at firstly 12 mg. kg-1 for the 30
      minutes, the second 30 minutes 9 mg. kg-1 and the BIS(bispectral index) values were arranged
      between 40-60 until the end of the operation), and remifentanil infusion (0.5 μg.kg-1 was
      applied as opioid and was arranged according to the tension artery and heart rate). In the
      dexmedetomidine group, dexmedetomidine infusion had started as 0.5 μg.kg-1 without making the
      loading dose and the dose change was not made. Rocuronium 0.5 mg. kg-1 iv. was applied for
      the endotracheal intubation. After the operation all patients have taken to the recovery
      room.

      Then the tests of cognitive function evaluation were repeated as postoperative 2nd hour, 24
      hours, 1 week and 1 month.
    

Detailed description: 
      After the approve of the Ethics Committee and the patients were informed and taken informed
      consent form from them (15 male and 25 female) totally 40 patients between the age of 20-60
      years old, who had lumbar disc hernia, under general anesthesia have been taken under the
      study. The patients with hepatic, renal or neurological diseases and using sedative-
      hypnotic, anticonvulsive and stimulant drugs and pregnant patients were excluded. Then they
      have been divided into two groups by closed envelope drawing method randomly and were allowed
      to stay hungry at least 8 hours. All the patients were applied the cognitive functions during
      the premedication visit MMSE (Mini Mental State Examination) that has quite practical usage
      and the test called Standardized Mini Mental Test Examination(SMMT-E) for the untrained
      persons. Test composed of question-answer in order to calculate the remembering, caution and
      calculation structure. All patients SMMTE scores were recorded. In the operation room,
      patients were applied the standard D-II derivation electrocardiography, heart beat rate,
      non-invasive arterial pressure, peripheral oxygen saturation (SpO2) and Bispectral Index
      (BİS) monitorization. Serum sale infusion was started by opening the vascular access with
      18-20 gauge cannula. The skin of forehead and the temporal side were cleaned with alcohol
      cotton for the BİS monitorization. The electrode in the proximal part of the three electrodes
      of disposable BİS sensor was adhered to the middle of the forehead; the distal electrode to
      the temporal area on the eye line and the other electrode in between them both were adhered.
      The BİS values (BİS Monitor, Aspect, USA) were continuously monitored. The Group I (TİVA, n=
      20) were received propofol-remifentanil and the Grup II (TİVA+D, n= 20) propofol-
      remifentanil and additional dexmedetomidine infusion.

      Induction of propofol infusion in all two groups was started as firstly 12 mg. kg-1 for the
      30 minutes, the second 30 minutes 9 mg. kg-1 and the BIS values were arranged between 40-60
      until the end of the operation. At the same time remifentanil infusion 0.5 μg.kg-1 was
      applied as opioid and arranged according to the tension artery and heart rate. The
      dexmedetomidine infusion has been started as 0.5 μg.kg-1 without making the loading dose and
      the dose change was not made. Rocuronium 0.5 mg. kg-1 iv. was applied for the endotracheal
      intubation. After intubation the carbon dioxide concentration was recorded in all periods.

      The patients were ventilated mechanically after the intubation in order to be ETCO2
      (end-tidal carbon dioxide) 30-44 mmHg, tidal volume 8-10 mL. kg-1 . In case of tachycardia or
      hypertension the opioid dose was reduced in case of bradycardia or hypertension while the
      opioid dose was being increased. Propofol infusion was arranged to be kept in between BİS
      score 40-50. The effect of the used muscle relaxant was returned by neostigmine 0,05- 0,07
      mg. kg-1 i.v. and atropin 0,03 mg. kg -1 i.v. After the operation all patients have been
      taken to the recovery room.

      Then the tests of cognitive function evaluation were repeated as postoperative 2nd hour, 24
      hours, 1 week and 1 month.
    

Intervention name(s): Remifentanil; Propofol; Dexmedetomidine; Rocuronium
Intervention type(s): Drug; Drug; Drug; Drug
Intervention description(s): In case of tachycardia or hypertension the opioid dose was reduced, in case of bradycardia or hypertension the opioid dose was increased; BIS values were arranged 40-60 until the end of operation; 0.5 microgram/kg infusion, no changes; 0.5 mg/kg iv for intubation, no change
Other intervention name(s): ultiva; precedex; esmeron
Intervention MeSH terms: Dexmedetomidine; Remifentanil; Propofol; Rocuronium
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Dexmedetomidine; cognitive functions; MMSE