Evaluating the Influence of the Strategy Intraoperative Anesthetic (Desflurane Versus Propofol) on Cognitive and Psychomotor Functions in Output Post Interventional Room Monitoring - COGNIDES

Study Overview
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Brief Summary
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The recovery of cognitive and psychomotor functions is best performed under anesthesia after desflurane when propofol in that obtaining a Aldrete score> 8/10 output of the allowing SSPI. The principal objective is to compare the cognitive and psychomotor status of patients recovered an Aldrete score> 8/10 according to the anesthetic agent (propofol or desflurane) using three tests (Stroop test, Digit Symbol Substitution task and a test of verbal memory (visual verbal learning test) made SSPI.

Detailed Description
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The day before surgery, patients sign the consent and will be randomized. Then 3 tests (Stroop test, Digit Symbol Substitution Task and visual verbal learning test) will be performed. No anxiolysis will be given to the patient. The anesthetic induction will be with IV propofol (2-3 mg / kg). The maintenance will anesthetic, desflurane by for a minimum alveolar concentration of between 2% and 6% or propofol for intravenous anesthesia user target controlled. In SSPI, the Aldrete score will be evaluated every 5min. Upon obtaining a Aldrete score> 8/10, the day before the tests will be carried out again

Official Title
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Randomized Study Evaluating the Influence of the Strategy Intraoperative Anesthetic (Desflurane Versus Propofol) on Cognitive and Psychomotor Functions in Output Post Interventional Room Monitoring

Conditions
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Orthopedic Surgery, Total Hip Prosthesis, Total Knee Replacement

Intervention / Treatment
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* Drug: Intraoperative anesthetic strategy by Propofol
* Drug: Intraoperative anesthetic strategy by Desflurane


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years and ≤ 80 years ASA I, II General anesthesia provided Scheduled orthopedic surgery Duration of surgery between one and three hours Patient has given its written consent Patient receiving medical health insurance Exclusion Criteria: MMS (Mini Mental State) ≤ 24 Patient does not speak or read or do not understand the French Previous surgery within seven days Coronary insufficiency, renal, hepatic Chronic pulmonary disease Obesity (BMI> 35) Addiction Chronic alcoholism Hematocrit <25% Personal and family history of malignant hyperthermia Taking benzodiazepines or psychotropic within 24 hours preoperative Psychiatric pathology being Psychological or neurological disorder causing difficulties in understanding the study Chronic pain and / or taking analgesics 3. Pregnancy or breastfeeding Disorder of hemostasis: platelets <80,000 / mm3, PT <50% TCA> 1.5 times the control. Hypersensitivity to propofol or desflurane or any of the excipients Patients allergic to soy and peanuts History of liver disease, jaundice, unexplained fever, eosinophilia after administration of a halogenated anesthetic Hypersensitivity to egg lecithin.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Propofol<br>Intraoperative anesthetic strategy by Propofol versus Desflurane | Drug: Intraoperative anesthetic strategy by Desflurane<br>* 2- Arm Desflurane Desflurane induction (2-3 mg / kg) Sufentanil (0.15 mg / kg IV) Atracurium (0.5 mg / kg IV)) Desflurane closed by maintenance target with minimal alveolar concentration (MAC) to adapt the circuit to obtain a figure 40 <BIS <60 Sufentanil bolus according to intraoperative analgesia Atracurium bolus according to the level of neuromuscular blockade<br>|
| Experimental: Desflurane<br>Intraoperative anesthetic strategy by Desflurane versus Propofol | Drug: Intraoperative anesthetic strategy by Propofol<br>* 1- Arm Propofol: Propofol TCI induction target between 2 and 6 mg / mL Sufentanil (0.15 mg / kg intravenously (IV)) Atracurium (0.5 mg / kg IV) Maintenance mode by Propofol TCI target between 2 and 4 micrograms / mL tune to 40 <BIS <60 Sufentanil bolus according to intraoperative analgesia Atracurium bolus according to the level of neuromuscular blockade<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare the cognitive and psychomotor status of patients recovered an Aldrete score> 8/10 according to the anesthetic agent (propofol or desflurane) | Compare the cognitive and psychomotor status of patients recovered an Aldrete score> 8/10 according to the anesthetic agent (propofol or desflurane), using three tests (Stroop test, Digit Symbol Substitution Task and test verbal memory (visual verbal learning test) made room post-interventional monitoring The primary endpoint will be the average score of three tests in room post-interventional monitoring (Stroop test, Digit Symbol Substitution Task, Visual Verbal Learning Test) scores expressed in standard deviation | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| proportion of patients with nausea and vomiting |  | 1 day | 
| Search intraoperative factors alterations in cognitive and psychomotor functions (number of red blood cells transfused, number of hypotensive episodes (≤ 80mmHg or MAP NOT ≤ 65mmHg)≥ 10 minutes). |  | 1 day | 
| Evaluate patient satisfaction on a visual analogue scale in room post-interventional monitoring |  | 1 day | 
| Evaluate postoperative pain in room post-interventional monitoring |  | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Orthopedic Surgery, Total hip prosthesis, Total knee replacement, Intraoperative anesthetic strategy, Propofol, Desflurane