Evidence map›Paper›PMID 22719840›Full record

Trial reportPloS one2012

Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial.

Clive Ballard, Emma Jones, Nathan Gauge, Dag Aarsland, Odd Bjarte Nilsen, Brian K Saxby, David Lowery, Anne Corbett, Keith Wesnes, Eirini Katsaiti and 6 more

Erratum issued 6 registry-linked trialsOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 6 registered trials, which are not on this map. Cited by 86 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
86citing papers in PubMed, 15 pooled it
11.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01743456 nacompletednot on this mapstarted 2014, after this paper: background citation

Effect of Depth of Anaesthesia on Postoperative Cognitive Decline in Patients Undergoing Coronary Artery Bypass Graft Surgery - a Prospectively Randomized Controlled Study

TypeinterventionalSponsorKing's College Hospital NHS TrustRan2014 to 2017Enrolled88ConditionsCardiac Bypass Surgery in Adult Patients 65 Years and Older, Postoperative Cognitive Dysfunction, Postoperative DeliriumArmsTargeted intra-operative depth of anaesthesia
NCT02428062 phase2 / phase3suspendednot on this mapstarted 2014, after this paper: background citation

Effect of Target Intraoperative Blood Pressure on the Incidence of Post-operative Cognitive Dysfunction in Patients Aged 75 and Older Undergoing General Anesthesia for Non-cardiac Surgery: an International Multicenter Randomized Controlled Trial

TypeinterventionalSponsorFondazione IRCCS Ca' Granda, Ospedale Maggiore PoliclinicoRan2014 to 2019Enrolled1,812ConditionsPost-operative Cognitive DysfunctionArmsHemodynamic target, Phenylephrine, Intravenous fluids, Patient's positioning, Reduction of depth of anesthesia
NCT03620968 nacompletednot on this mapstarted 2018, after this paper: background citation

"Implementation of a Cognitive Training Program in the Elderly to Reduce the Risk of Postoperative Cognitive Dysfunction in Elective Non-cardiac Surgery "

TypeinterventionalSponsorCentro Medico TeknonRan2018 to 2022Enrolled225ConditionsPostoperative Cognitive DysfunctionArmscognitive training
NCT03696719 naunknown statusnot on this mapstarted 2018, after this paper: background citation

Anesthetic Method and Cerebral Outcomes: A Prospective Randomized Controlled Trial.

TypeinterventionalSponsorRabin Medical CenterRan2018 to 2021Enrolled140ConditionsAnesthesia, Neuron DegenerationArmsBIS bispectral index monitoring device, NSE cerebral biomarker testing
NCT04016740 early_phase1completednot on this mapstarted 2019, after this paper: background citation

Perioperative Multimodal General Anesthesia Focusing on Specific CNS Targets in Patients Undergoing Cardiac Surgeries

TypeinterventionalSponsorBeth Israel Deaconess Medical CenterRan2019 to 2020Enrolled22ConditionsCoronary Artery Disease, DeliriumArmsRopivacaine, Ketamine, Remifentanil, Dexmedetomidine, Rocuronium
NCT04198077 phase4unknown statusnot on this mapstarted 2019, after this paper: background citation

Conservative vs Conventional Oxygen Administration in Critically Ill Patients: Effects on ICU Mortality. A Multicentre Randomized Open Label Clinical Trial

TypeinterventionalSponsorUniversity of Modena and Reggio EmiliaRan2019 to 2023Enrolled1,000ConditionsCritical Illness, Respiration, Artificial, Hyperoxia, HyperoxemiaArmsOxygen
3 · Its place in the literature

Who cites it

86 citing papers in PubMed, 15 syntheses or guidelines pooled it, 243 citations in OpenAlex.

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26 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

  • Erratum issued
    Amaoko, Derek [corrected to Amoako, Derek]
  • Erratum issued
5 · Who and what money

Authors and funding

16 authors at 8 institutions in 4 countries.

Clive BallardWolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom. Clive.ballard@kcl.ac.uk
Emma Jones
Nathan Gauge
Dag Aarsland
Odd Bjarte Nilsen
Brian K Saxby
David Lowery
Anne Corbett
Keith Wesnes
Eirini Katsaiti
James Arden
Derek Amoako
Derek Amaoko
Nicholas Prophet
Balaji Purushothaman
David Green
King's College Hospital · GBKing's College London · GBAlzheimer's Society · GBKarolinska Institutet · SENewcastle Hospitals - Campus for Ageing and Vitality · GBStavanger University Hospital · NOSwinburne University of Technology · AUUniversity College London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe study determined the one year incidence of post operative cognitive decline (POCD) and evaluated the effectiveness of an intra-operative anaesthetic intervention in reducing post-operative cognitive impairment in older adults (over 60 years of age) undergoing elective orthopaedic or abdominal surgery. METHODS AND TRIAL

designThe design was a prospective cohort study with a nested randomised, controlled intervention trial, using intra-operative BiSpectral index and cerebral oxygen saturation monitoring to enable optimisation of anaesthesia depth and cerebral oxygen saturation in older adults undergoing surgery.

resultsIn the 52 week prospective cohort study (192 surgical patients and 138 controls), mild (χ(2) = 17.9 p<0.0001), moderate (χ(2) = 7.8 p = 0.005) and severe (χ(2) = 5.1 p = 0.02) POCD were all significantly higher after 52 weeks in the surgical patients than among the age matched controls. In the nested RCT, 81 patients were randomized, 73 contributing to the data analysis (34 intervention, 39 control). In the intervention group mild POCD was significantly reduced at 1, 12 and 52 weeks (Fisher's Exact Test p = 0.018, χ(2) = 5.1 p = 0.02 and χ(2) = 5.9 p = 0.015), and moderate POCD was reduced at 1 and 52 weeks (χ(2) = 4.4 p = 0·037 and χ(2) = 5.4 p = 0.02). In addition there was significant improvement in reaction time at all time-points (Vigilance Reaction Time MWU Z = -2.1 p = 0.03, MWU Z = -2.7 p = 0.004, MWU Z = -3.0 p = 0.005), in MMSE at one and 52 weeks (MWU Z = -2.9 p = 0.003, MWU Z = -3.3 p = 0.001), and in executive function at 12 and 52 weeks (Trail Making MWU Z = -2.4 p = .0.018, MWU Z = -2.4 p = 0.019).

conclusionPOCD is common and persistent in older adults following surgery. The results of the nested RCT indicate the potential benefits of intra-operative monitoring of anaesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive impairment.

trial registrationControlled-Trials.com ISRCTN39503939.

Indexed as

AnesthesiaElective Surgical ProceduresPostoperative ComplicationsAgedAged, 80 and overCognition DisordersHumansLongitudinal StudiesProspective Studies

Identifiers

PMID22719840
PMCPMC3376123
OpenAlexW2103605221

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.