Shaping anesthetic techniques to reduce post-operative delirium (SHARP) study: a protocol for a prospective pragmatic randomized controlled trial to evaluate spinal anesthesia with targeted sedation compared with general anesthesia in older adults undergoing lumbar spine fusion surgery

作者：Charles H. Brown, Emily Jones, Charles Y. Lin, Melody Esmaili, Yara Gorashi, Richard Skelton, Daniel Kaganov, Elizabeth Colantuoni, Lisa R. Yanek, Karin J. Neufeld, Vidyulata Kamath, Frederick E. Sieber, Clayton L. Dean, Charles C. Edwards, Charles W. Hogue · 发表于：BMC Anesthesiology · 年份：2019 · DOI：10.1186/s12871-019-0867-7 · 被引用次数：20 · 研究领域：Intensive Care Unit Cognitive Disorders、Anesthesia and Sedative Agents、Pain Management and Opioid Use

BACKGROUND: Postoperative delirium is common in older adults, especially in those patients undergoing spine surgery, in whom it is estimated to occur in > 30% of patients. Although previously thought to be transient, it is now recognized that delirium is associated with both short- and long-term complications. Optimizing the depth of anesthesia may represent a modifiable strategy for delirium prevention. However, previous studies have generally not focused on reducing the depth of anesthesia beyond levels consistent with general anesthesia. Additionally, the results of prior studies have been conflicting. The primary aim of this study is to determine whether reduced depth of anesthesia using spinal anesthesia reduces the incidence of delirium after lumbar fusion surgery compared with general anesthesia. METHODS: This single-center randomized controlled trial is enrolling 218 older adults undergoing lumbar fusion surgery. Patients are randomized to reduced depth of anesthesia in the context of spinal anesthesia with targeted sedation using processed electroencephalogram monitoring versus general anesthesia without processed electroencephalogram monitoring. All patients are evaluated for delirium using the Confusion Assessment Method for 3 days after surgery or until discharge and undergo assessments of cognition, function, health-related quality of life, and pain at 3- and 12-months after surgery. The primary outcome is any occurrence of delirium. The main secondary outcome is...