Intravenous Versus Inhalational Anesthesia in Parkinson's Disease

NCT00615472 | Terminated Results

• 1 other identifier: AAAA4885
• Study Type: interventional
• Target: 58
• Locations: 1 country
• Sites: 1

Brief Summary

Parkinson's disease is a common progressive degenerative disease affecting 3% of all patients over the age of 65. Given their age and frailty, these patients frequently require surgical procedures with general anesthesia. However, after surgery, patients with Parkinson's disease have longer hospital stays and a greater chance of not returning to independent living compared to age-matched controls (Berman MF, unpublished data). In part, this is due to a higher rate of post-operative delirium, which had an incidence of 60% in this population in one study. There is anecdotal evidence from neurologists specializing in movement disorder suggesting that there is also significant deterioration in parkinsonian motor symptoms and cognition lasting for months or years following surgery and anesthesia. The basis for this deterioration is unknown. We hypothesize that these problems are caused by particular medications used during inhaled anesthesia for surgical procedures.

Conditions

Parkinson's Disease

Keywords

Parkinson's Disease; Deep brain stimulation (DBS); Subthalamic Nucleus; Total Intravenous Anesthesia; Inhalational Anesthesia

Outcome Measures

Primary Outcomes (1)

• Number of Participants With Improved Postoperative Delirium and Cognitive and Motor Changes

  A battery/Questionnaire of neuropsych examinations is given to the subjects to measure improvement based on change of scores and standard deviation. The battery consists of questions regarding delirium, cognitive and motor changes and yields a combination assessment of all 3 elements.

  Four months

Study Arms (2)

Group 1

EXPERIMENTAL

Inhaled Anesthesia - isoflurane

Drug: Isoflurane

Group 2

EXPERIMENTAL

Intravenous Anesthesia - propofol, remifentanil

Drug: Remifentanil; Drug: Propofol

Interventions

Isoflurane DRUG

Group 1 Inhaled anesthesia Patients will be maintained on 50% oxygen in air and isoflurane 0 to 4%, titrated as needed to maintain a standard blood pressure (standard practice). If needed, muscle relaxation will be provided by additional boluses or an infusion of mivacurium (4-10 ug/kg/min).

Also known as: Forane

Group 1

Remifentanil DRUG

Group 2 Intravenous anesthesia Patients will be ventilated with 50% oxygen in air. Patients will receive continuous propofol infusion 0.05 mg/kg-min to 0.15 mg/kg-min titrated as needed; and remifentanil (ultra-short acting narcotic) 0.1 ug/kg-min to 0.5 ug/kg-min. These will be titrated as needed to maintain a standard blood pressure. Both infusions will be turned off at the end of the procedure. If needed, muscle relaxation will be provided by additional boluses or an infusion of mivacurium (4-10 ug/kg/min).

Also known as: Ultiva

Group 2

Propofol DRUG

Group 2 Intravenous anesthesia Patients will be ventilated with 50% oxygen in air. Patients will receive continuous propofol infusion 0.05 mg/kg-min to 0.15 mg/kg-min titrated as needed; and remifentanil (ultra-short acting narcotic) 0.1 ug/kg-min to 0.5 ug/kg-min. These will be titrated as needed to maintain a standard blood pressure. Both infusions will be turned off at the end of the procedure. If needed, muscle relaxation will be provided by additional boluses or an infusion of mivacurium (4-10 ug/kg/min).

Also known as: Diprivan

Group 2

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Clinical diagnosis of Parkinson's Disease with bilateral deep brain stimulation surgery indicated as treatment

You may not qualify if:

• Not fluent in English

Sponsors & Collaborators

• Columbia University: lead

Study Sites (1)

Columbia Unviversity, Deparment of Anesthesiology

New York, New York, 10032, United States

Location

Related Publications (15)

• Corder EH, Saunders AM, Strittmatter WJ, Schmechel DE, Gaskell PC, Small GW, Roses AD, Haines JL, Pericak-Vance MA. Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. Science. 1993 Aug 13;261(5123):921-3. doi: 10.1126/science.8346443.

  PMID: 8346443 BACKGROUND

• Friedman G, Froom P, Sazbon L, Grinblatt I, Shochina M, Tsenter J, Babaey S, Yehuda B, Groswasser Z. Apolipoprotein E-epsilon4 genotype predicts a poor outcome in survivors of traumatic brain injury. Neurology. 1999 Jan 15;52(2):244-8. doi: 10.1212/wnl.52.2.244.

  PMID: 9932938 BACKGROUND

• Brandt R, Spencer M, Folstein M: The Telephone Interview for Cognitive Status. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 1:111-117, 1988.

  BACKGROUND

• Culley DJ, Yukhananov RY, Baxter MB, Crosby G: Longerterm cognitive performance after general anesthesia in aged rats. J Neurosurg Anesthesiol 12:395 (abstract 325), 2000.

  BACKGROUND

• Golden WE, Lavender RC, Metzer WS. Acute postoperative confusion and hallucinations in Parkinson disease. Ann Intern Med. 1989 Aug 1;111(3):218-22. doi: 10.7326/0003-4819-111-3-218.

  PMID: 2751180 BACKGROUND

• Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998 Mar 21;351(9106):857-61. doi: 10.1016/s0140-6736(97)07382-0.

  PMID: 9525362 BACKGROUND

• Newman MF, Croughwell ND, Blumenthal JA, Lowry E, White WD, Spillane W, Davis RD Jr, Glower DD, Smith LR, Mahanna EP, et al. Predictors of cognitive decline after cardiac operation. Ann Thorac Surg. 1995 May;59(5):1326-30. doi: 10.1016/0003-4975(95)00076-w.

  PMID: 7733762 BACKGROUND

• Patten D, Foxon GR, Martin KF, Halliwell RF. An electrophysiological study of the effects of propofol on native neuronal ligand-gated ion channels. Clin Exp Pharmacol Physiol. 2001 May-Jun;28(5-6):451-8. doi: 10.1046/j.1440-1681.2001.03469.x.

  PMID: 11380521 BACKGROUND

• Pepper PV, Goldstein MK. Postoperative complications in Parkinson's disease. J Am Geriatr Soc. 1999 Aug;47(8):967-72. doi: 10.1111/j.1532-5415.1999.tb01292.x.

  PMID: 10443858 BACKGROUND

• Ruberg M, Ploska A, Javoy-Agid F, Agid Y. Muscarinic binding and choline acetyltransferase activity in Parkinsonian subjects with reference to dementia. Brain Res. 1982 Jan 28;232(1):129-39. doi: 10.1016/0006-8993(82)90615-1.

  PMID: 7055689 BACKGROUND

• Spreen O, Strauss E: A compendium of Neuropsychological tests. New York, Oxford University Press, 1998, ed second.

  BACKGROUND

• van Laar T, Jansen EN, Essink AW, Neef C, Oosterloo S, Roos RA. A double-blind study of the efficacy of apomorphine and its assessment in 'off'-periods in Parkinson's disease. Clin Neurol Neurosurg. 1993 Sep;95(3):231-5. doi: 10.1016/0303-8467(93)90128-4.

  PMID: 8242966 BACKGROUND

• Violet JM, Downie DL, Nakisa RC, Lieb WR, Franks NP. Differential sensitivities of mammalian neuronal and muscle nicotinic acetylcholine receptors to general anesthetics. Anesthesiology. 1997 Apr;86(4):866-74. doi: 10.1097/00000542-199704000-00017.

  PMID: 9105231 BACKGROUND

• Williams-Russo P, Sharrock NE, Mattis S, Szatrowski TP, Charlson ME. Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA. 1995 Jul 5;274(1):44-50.

  PMID: 7791257 BACKGROUND

• Ali HH, Savarese JJ, Embree PB, Basta SJ, Stout RG, Bottros LH, Weakly JN. Clinical pharmacology of mivacurium chloride (BW B1090U) infusion: comparison with vecuronium and atracurium. Br J Anaesth. 1988 Nov;61(5):541-6. doi: 10.1093/bja/61.5.541.

  PMID: 2905143 BACKGROUND

MeSH Terms

Conditions

Parkinson Disease

Interventions

Isoflurane; Remifentanil; Propofol

Condition Hierarchy (Ancestors)

Parkinsonian Disorders; Basal Ganglia Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases

Intervention Hierarchy (Ancestors)

Methyl Ethers; Ethers; Organic Chemicals; Propionates; Acids, Acyclic; Carboxylic Acids; Piperidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Phenols; Benzene Derivatives; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons

Results Point of Contact

• Title: Eric J Heyer
• Organization: Columbia University

ejh3@cumc.columbia.edu

212-305-9072

Study Officials

• Eric J Heyer, M.D., Ph.D.

  Columbia University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: DIAGNOSTIC
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Clinical Anesthesiology

Study Record Dates

• First Submitted: January 9, 2008
• First Posted: February 14, 2008
• Study Start: October 1, 2003
• Primary Completion: April 1, 2010
• Study Completion: April 1, 2011
• Last Updated: July 13, 2015
• Results First Posted: July 13, 2015

Record last verified: 2015-06

Locations

US (1)