Comparison of Neuroprotection by Propofol and Desflurane for POCD Following Subarachnoid Hemorrhage Surgery
Condition: Postoperative Cognitive Function
MeSH terms: Subarachnoid Hemorrhage; Hemorrhage
Study type: Interventional
Phase: Phase 4

Summary: 
      Aneurysmal subarachnoid hemorrhage (aSAH) is characterized by the rupture of an intracranial
      aneurysm and accumulation of blood in the subarachnoid space with 30 to 40% mortality rate.
      Amongst the survivors 40-50% suffers disability due to cognitive decline.Trends towards early
      surgery offers challenge to anesthesiologist to provide optimum brain relaxation and
      simultaneously maintaining stable hemodynamics. Anesthetic agents are administered to conduct
      smooth neurosurgical procedure. These agents may affect patient's cognitive function
      postoperatively.Currently most common anesthetic agents used are either intravenous hypnotic
      agents (propofol) or volatile inhalational agents (isoflurane/sevoflurane/desflurane).
      Provision of neuroprotection with propofol and volatile inhalational agents has been studied
      by various authors.Not many studies have been performed in patients undergoing aneurysmal
      clipping surgeries looking into effects of various anesthetic agents on intraoperative (I/O)
      brain condition, I/O hemodynamic and POCD.Thus present study is planned to compare propofol
      and desflurane for long term postoperative cognitive decline in patients undergoing surgery
      following aneurysmal subarachnoid hemorrhage.
    

Detailed description: 
      100 patients will be randomized into two groups, Desflurane group (Group D) and Propofol
      group (Group P) using a computer generated algorithm. Written informed consent will be taken
      from all the patients.

      Cognition assessed using MOCA (Montreal Cognitive Assessment)test. A preoperative assessment
      for establishing the patient's baseline performance. Surgery-related factors may affect test
      performance if performed too early to reduce possibility of confounding factors, we planned
      to conduct the test for POCD at the time of discharge of the patient after surgery. To
      compare long term protection provided by anesthetic agent cognitive functions were assessed
      at one month following surgery.

      Cognitive functions will be assessed at following time period A) Preoperatively B)
      Postoperatively B1- At the time of discharge B2- 1month after discharge following surgery.

      Biomarker levels S100B levels were also measured A) Preoperatively B) Intraoperatively - post
      clipping C) Postoperatively - 1hour after surgery
    

Intervention name(s): Propofol; Desflurane
Intervention type(s): Drug; Drug
Intervention description(s): Intravenous hypnotic agent Decrease Cerebral Metabolic reduction Decrease ICP Better cognitive Function preservation; Inhalational agent. Decreases cerebral metabolism Increase /decreases ICP Cognition preservation
Intervention MeSH terms: Propofol; Desflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Prevention
Keywords: POCD; subarachnoid hemorrhage; Propofol; Desflurane