Opioid Reduced Anesthesia With Parasternal CATheters on Postoperative Delirium After Cardiac Surgery

Study Overview
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Brief Summary
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PostOperative Delirium (POD) is the most common neuropsychiatric complication following cardiac surgery and may be related to morphine consumption. PostOperative Delirium (POD) prolongs hospital and intensive care unit (ICU) length of stay (LOS) and increases morbidity and mortality. No study has been conducted to demonstrate the effect of regional anesthesia using catheters inserted before sternotomy.

Detailed Description
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This study investigate the effect of an enhanced recovery protocol using regional anesthesia on PostOperative Delirium (POD) onset.

Official Title
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Opioid Reduced Anesthesia With Parasternal CATheters on Postoperative Delirium After Cardiac Surgery

Conditions
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Cardiac Disease

Intervention / Treatment
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* Other: collection of datas


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age over 18 Admitte for scheduled cardiac surgery with sternotomy under cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG), surgical correction of valve disease (aortic, mitral or tricuspid) or combined surgery (coronary artery bypass grafting (CABG) and valve replacement). Exclusion Criteria: Age over 85, emergency surgery or heart transplant, body mass index (BMI) more than 40 kg.m-2 reoperation Renal insufficiency with glomerular filtration rate (GFR) less than 30 mL.min-1 left ventricular ejection fraction less than 30% respiratory insufficiency with arterial pressure of oxygen less than 60 mmHg hepatic insufficiency with prothrombin rate less than 30% or cirrhosis chronic hyperglycemia not controlled pregnancy cognitive impairment chronic use of opioids or drug addiction epilepsy guardianship allergy to locals anesthesics or any drugs

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| opioid reduced anesthesia with parasternal catheters inserted before sternotomy<br>Patients with opioid reduced anesthesia with parasternal catheters inserted before sternotomy will be included. | Other: collection of datas<br>* collection of datas: Post-operative occurrence (within the first 48 hours after extubation) of post-operative delirium via the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) scale result Post-operative hypoxemia defined as a PaO2/FiO2 ratio < 300 in the first 48 hours after extubation reflex ileus defined as the absence of gas and/or matter in the first 48 hours after extubation, total morphine consumption in the first 48 hours after surgery pain at 24 hours and 48 hours after surgery post-operative nausea and vomiting, major complications (neurological, respiratory, cardiac, infectious) mortality 30 days after surgery<br>|
| Opioid Anesthesia (OA)<br>Patients with Opioid Anesthesia (OA) will be included. | Other: collection of datas<br>* collection of datas: Post-operative occurrence (within the first 48 hours after extubation) of post-operative delirium via the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) scale result Post-operative hypoxemia defined as a PaO2/FiO2 ratio < 300 in the first 48 hours after extubation reflex ileus defined as the absence of gas and/or matter in the first 48 hours after extubation, total morphine consumption in the first 48 hours after surgery pain at 24 hours and 48 hours after surgery post-operative nausea and vomiting, major complications (neurological, respiratory, cardiac, infectious) mortality 30 days after surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Postoperative delirium (POD) assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in the first 48 hours after surgery | assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium is diagnosed when criteria 1 and 2 are positive, as well as criteria 3 or 4. | Hours: 48 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of hypoxemia postoperative in the first 48 hours after extubation | Data collected in medical record: PaO2/FiO2 < 300 | Hours: 48 | 
| Number of Ileus postoperative in the first 48 hours after extubation | Data collected in medical record:absence of gas and/or material | Hours: 48 | 
| Total morphine consumption within 48h after extubation | Data collected in medical record | Hours: 48 | 
| Pain at 24 hours and 48 hours postoperative | Data collected in medical record | Hours: 24, 48 | 
| postoperative nausea and vomiting | Data collected in medical record. | Hours: 48 | 
| major complications (neurological, respiratory, cardiac, infectious) | Data collected in medical record. | Hours: 48 | 
| mortality at 30 days after surgery | Data collected in medical record. | Day: 30 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac surgery, postoperative delirium, regional anesthesia, enhanced recovery after surgery