Clinical trial NCT06005363: CSF Metabolomics and Glymphatic Function in Patients Receiving VP- Shunt Surgery.
Official title: The Application of Anesthesia Depth Monitoring on Post-operative Cognitive Dysfunction for Patients With Hydrocephalus Receiving Ventricular-peritoneal Shunt Surgery and Associated Change in CSF Metabolomics and Glymphatic Function.
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: The Association of Postoperative Cognitive Dysfunction With Glymphatic Function and Neuroinflammation
The Association of Postoperative Cognitive Dysfunction With CSF Metabolomic Change
Keywords: anesthesia depth monitoring
postoperative cognitive dysfunction
metabolomics
cerebrospinal fluid
glymphatic function
Lead sponsor: Chang Gung Memorial Hospital
Sponsor class: OTHER
First posted: 2023-08-22
Enrollment: 48
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Two interventional group with BIS group and DEX group all receive BIS monitoring, and DEX group receive dexmedetomidine infusion.
Primary purpose: DIAGNOSTIC

Brief summary: In this randomized control study, the investigators intended to evaluate the influence of different anesthetics on postoperative cognitive dysfunction, neuroinflammation, CSF metabolomics, and glymphatic function in patients with normal pressure hydrocephalus for VP shunt surgery. The investigators assume that the use of dexmedetomidine infusion and proper anesthsia depth during general anesthesia, in addition to multi-model analgesia, might be helpful to enhance glymphatic function, reduce neuroinflammation, and decrease postoperative cognitive dysfunction.

Detailed description: In this prospective randomized controlled study, 48 patients with communicating hydrocephalus will be enrolled in the study and these patients will be divided into 3 groups in which intervention group received anesthesia depth monitoring (BIS group and DEX group) and dexmedetomidine infusion (DEX group), while the controlled group received usual anesthesia care without dexmedetomidine during VP shunt surgery. The participant's intraoperative CSF and plasma samples will be collected for biochemical analysis and metabolomic analysis. The investigators will use two analytical metabolomic platforms, including nuclear magnetic resonance (NMR) and liquid chromatography-mass spectrometry (LC-MS), to execute quantitative metabolomics on human CSF and plasma samples. These metabolomic data will be compared with previous established human aging CSF Metabolome Database. After VP shunt surgery, these patient's glymphatic function will be evaluated with 3T functional MRI. The postoperative cognitive function and delirium status of these patients will be evaluated for the following 3 days using MMSE score, Montreal Cognitive Assessment, and CAM-ICU score. During analysis, the pre-operative metabolomic signature of patients with postoperative cognitive dysfunction(POCD) will be compared with patients without POCD to profile the metabolomics of POCD. Besides, the investigators could examine the correlation of glymphatic function and POCD. By comparing the CSF metabolomic change in these three groups, the investigators could evaluate the the efficacy of anesthesia depth monitoring and dexmedetomidine to reduce POCD development during VP shunt surgery. The result of this study might be able to explain the brain pathophysiology of POCD, the role of glymphatic function in POCD, metabolomic signature of POCD, and establish a better anesthesia regimen to reduce the development of POCD.

Eligibility criteria: Inclusion Criteria:

* patients with communicating hydrocephalus for elective VP shunt surgery under general anesthesia
* age\> 60 y/o
* conscious clear
* fluency in Chinese
* anticipated hospital stay ≥ 3 days after surgery

Exclusion Criteria:

* unstable preoperative condition (unstable angina, CHF, asthma attack) within 4 weeks before surgery,
* severe hepatic dysfunction or renal failure
* history of neuropsychological diseases such as schizophrenia, Parkinson's disease, dementia, stroke,
* pre-op cognitive impairment,
* preoperative delirium,
* preoperative depression,
* allergy to contrast medium of MRI.

Primary outcomes:
measure: Postoperative cognitive function
timeFrame: postoperative 2 hours, postoperative day 1, postoperative day 2, postoperative day 3
measure: NMR amd LC-MS CSF and plasma metabolomics
timeFrame: preoperative, postoperative 2 hours, postoperative day 1
Secondary outcomes:
measure: Neuroinflammation parameters
timeFrame: preoperative, postoperative 2 hours, postoperative day 1
measure: Glymphatic function
timeFrame: preoperative, postoperative day 1
Other outcomes:
Locations:
city: Taoyuan
country: Taiwan
facility: Linkou Chang Gung Memorial Hospital
Study officials:
affiliation: Department of anesthesiology, Linkou Chang Gung Memorial Hospital
name: Huan-tang Lin
role: PRINCIPAL_INVESTIGATOR
References: