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

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 change in the Mini-Mental Status Examination (or telephone equivalent) at 3-months after surgery.

DISCUSSION

Delirium is an important complication after surgery in older adults. The results of this study will examine whether reduced depth of anesthesia using spinal anesthesia with targeted depth of sedation represents a modifiable intervention to reduce the incidence of delirium and other long-term outcomes. The results of this study will be presented at national meetings and published in peer-reviewed journals with the goal of improving perioperative outcomes for older adults.

TRIAL REGISTRATION

Clinicaltrials.gov , NCT03133845. This study was submitted to Clinicaltrials.gov on October 23, 2015; however, it was not formally registered until April 28, 2017 due to formatting requirements from the registry, so the formal registration is retrospective.

Investigation of new indole derivatives of bovine serum albumin using spectroscopic and molecular docking techniques

We investigated the interaction of two derivatives of bis (indolyl) methane with bovine serum albumin (BSA) using spectroscopic and molecular docking calculations. Fluorescence quenching measurements revealed that the quenching mechanism was static. Fӧrster energy transfer measurements, synchronous fluorescence spectroscopy and docking studies demonstrated that both bis(indolyl)methanes bound to the Trp residues of BSA. The docking study confirmed that both bis(indolyl)methanes form hydrogen bonds and van der Waals interactions with BSA. Our molecular docking study indicated that the compounds are located within the binding pocket of subdomains IIB and IB of BSA. Fourier transform infrared spectroscopy demonstrated that both bis(indolyl)methane derivatives can interact with BSA and can affect the secondary structure of BSA.

[Ophidian envenomation in the region Souss-Massa-Drâa in Morocco]

The present study aims to determine the main characteristics of ophidian envenomation in the Souss-Massa-Drâa region in Morocco. It consisted of a descriptive retrospective analysis of all snakebite cases recorded by the Moroccan Poison Control and Pharmacovigilance Center, from 1980 to 2008. According to reported data, this region is the most affected in Morocco with 479 cases, that is 27.6% (17 cases/year). The average age of victims was 26.07 ± 18.28 years. The patients developed clinical signs (55%) dominated by disorders of the digestive system (35.5%), cardiovascular diseases (21.4%), and heart rhythm disorders (16.8%). The lethality and sequelae rates were 12% and 1.9%, respectively.

Corticosteroid therapy of experimental hydrocephalus after intraventricular-subarachnoid haemorrhage

Symptomatic hydrocephalus after subarachnoid haemorrhage seems to result both from mechanical obstruction of arachnoid villi and basilar cisterns and from an inflammatory cellular reaction in the villi. Subarachnoid haemorrhage was induced in rabbits using whole blood injected through an implanted intraventricular needle. Control rabbits receiving intraventricular methyl prednisolone acetate but no blood, developed ventricular dilation significantly more often than untreated controls. Eighty-three per cent of rabbits with untreated experimental subarachnoid haemorrhage developed moderate to severe hydrocephalus. Intramuscular steroid therapy significantly reduced the incidence of hydrocephalus.