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Explicit Recall of Intra-Operative EventsPhase 4BAG-RECALLNCT00682825

Study Evaluating Whether the Bispectral Index Prevents Patients at Higher Risk From Being Awake During Surgery and Anesthesia

A Phase 4 study testing Bispectral index protocol and End tidal anesthetic gas-guided in people with Explicit Recall of Intra-Operative Events, run by Washington University School of Medicine at 3 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The overall purpose of this study is to see if a Bispectral Index (BIS) monitor, a Food and Drug Administration (FDA) approved brain monitoring device, will help to reduce the risk of patients remembering being awake during surgery. The BIS monitor may be able to measure how asleep a patient is during surgery. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Bispectral index protocol and End tidal anesthetic gas-guided
Could I receive a placebo?
No, everyone receives an active treatment
How many people
6,000 participants
Where
3 sitesin 2 countries
Study dates
Mar 2008to Dec 2010
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • MUST HAVE:
  • General Anesthesia with volatile anesthetic
  • PATIENT CHARACTERISTICS
  • Major Criteria (Must have any 1 of the following:)
  • Planned open heart surgery
  • Medications - anticonvulsants, abuse of opiates, benzodiazepines, cocaine
Show all 15Show fewer
  • EF<40%
  • Prior history of awareness (recall)
  • History of difficult intubation or anticipated difficult intubation
  • ASA IV or V status
  • Aortic stenosis
  • End stage lung disease
  • Marginal exercise tolerance not secondary to musculoskeletal dysfunction
  • Pulmonary hypertension
  • Daily alcohol consumption

Who cannot join

  • Surgical procedure that prevents the use of the BIS (e.g. surgery of forehead)
  • Patient positioning prevents use of the BIS
  • Surgery with wake-up test.
  • Less than 18 years of age
  • Vulnerable populations, such as those with dementia and those unable to provide informed consent.
  • Stroke with residual neurological deficits
  • -

Trial locations and contacts

3 sites in 2 countries.

3 sites in 2 countries

United States2 sites
  • University of Chicago

    Chicago, Illinois

  • Washington University

    St Louis, Missouri, 63110

Other trials in United States

Canada1 site
  • University of Manitoba

    Winnipeg, Manitoba

Other trials in Canada

About this study

Official title: BAG-RECALL Study: BIS or Anesthesia Gas to Reduce Explicit Recall

The overall purpose of this study is to see if a Bispectral Index (BIS) monitor, a Food and Drug Administration (FDA) approved brain monitoring device, will help to reduce the risk of patients remembering being awake during surgery. The BIS monitor may be able to measure how asleep a patient is during surgery. Using the BIS monitor to guide anesthesia will be compared with using the concentration of anesthetic gas to guide anesthesia.

Read the detailed description

The incidence of anesthesia awareness (AA) is 0.1-0.2% and may result in post traumatic stress disorders. For some patients, owing to illness, medications, substance misuse or surgery, the risk approaches 1%. The B-AWARE Study by Myles et al. suggested that the bispectral index (BIS) monitor, which reportedly reflects anesthetic depth, may decrease the incidence of AA in higher risk patients by 82%. The American Society of Anesthesiologists has published a practice advisory on AA, which does not recommend the routine use of cerebral function monitors. We propose to test the hypothesis that an anesthetic protocol based on BIS decreases the incidence of AA among higher risk patients compared with an anesthetic protocol based on the end-tidal anesthetic gas (ETAG) concentration. We have completed a randomized, single-blinded prospective feasibility study (The B-Unaware Trial) which enrolled 2000 patients at higher risk for AA. Four patients (0.21%; 95% CI=0.06% to 0.57%) had definite AA, of whom two were in the BIS-guided group and two in the ETAG-guided group. Nine patients (0.46%; 95% CI=0.22% to 0.91%) had definite or possible AA, of whom six were in the BIS-guided group and three in the ETAG-guided group. The BAG RECALL study will be a multi-center, prospective, single-blinded, randomized study enrolling 6000 patients at higher risk for AA. The BAG RECALL study is adequately powered and rigorously designed to answer with a reasonable degree of scientific probability whether BIS guidance results in clinically relevant reduction in anesthesia awareness among higher risk patients undergoing general anesthesia.

At the University of Michigan, a parallel study will be conducted - Michigan Awareness Control Study, MACS (NCT00689091) - enrolling 30,000 patients to assess whether the BIS monitor decreases the likelihood of anesthesia awareness among all patients undergoing general anesthesia, regardless of their risk profile. The investigators of this study and the BAG-RECALL study have collaborated in designing these studies and are pre-specifying that common outcome measures will be examined collaboratively including data from both studies.

Being tested
Bispectral index protocol, End tidal anesthetic gas-guided
Keywords
Anesthesia, Awareness, Bispectral, BIS, Recall

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bispectral index protocolBehavioural

    Aim to titrate anesthesia to maintain BIS between 40 and 60.

  • End tidal anesthetic gas-guidedBehavioural

    Aim to maintain anesthetic gas between 0.7 and 1.3 MAC equivalents

Study groups in NCT00682825
Study groupRoleWhat they receive
1ExperimentalBispectral index-guided protocol
Receives: Behavioral: Bispectral index protocol
2Active comparatorEnd-tidal anesthetic gas-guided protocol
Receives: Behavioral: End tidal anesthetic gas-guided

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The incidence of explicit recall of events during the surgical and anesthetic periods.

    Measured: Three years

Secondary outcomes (25)
  1. Meta-analysis for anesthesia awareness incorporating higher risk patients from the completed B-Unaware Trial (NCT00281489), the BAG-RECALL Trial, and the Michigan Awareness Control Study (MACS)(NCT00689091).

    Measured: Three years

  2. Incidence of post-traumatic stress disorder (PTSD).

    Measured: Five years

  3. Association between type of awareness event and PTSD, and whether the PTSD is associated with late reporting (30 days) of awareness.

    Measured: 5 years

  4. Types of dreams and their relationship to BIS and ETAG.

    Measured: Three years

  5. The relationship between deep hypnotic time, anesthetic dose (MAC), mean arterial pressure, and end tidal carbon dioxide, and early (one-month) and late (one-year) mortality.

    Measured: Four years

  6. Relationship between BIS, heart rate and blood pressure.

    Measured: Three years

  7. Relationship between BIS and anesthesia dose and concentration.

    Measured: Three years

  8. Association between baseline BIS values, patient health and early (one-month) and late (one-year) mortality.

    Measured: Four years

  9. Interaction between hemispheric dominance and BIS.

    Measured: Three years

  10. Effect of red hair phenotypes on the relationship between ETAG and BIS.

    Measured: Three years

  11. Refinement of risk factors for anesthesia awareness.

    Measured: Three years

  12. Relationship between rising BIS in the PACU and first memory after surgery.

    Measured: Three years

  13. Postoperative delirium.

    Measured: Three years

  14. BIS and mixed venous saturation.

    Measured: Three years

  15. Induction of anesthesia and hypotension.

    Measured: Three years

  16. Incidence of postoperative nausea and vomiting.

    Measured: Three years

  17. Incidence of and severity of postoperative pain.

    Measured: Three years

  18. Effect of BIS and ETAG protocols on time to open eyes, time to extubation, and time spent in the postoperative recovery unit.

    Measured: Three years

  19. Effect of a defasciculating dose of a non-depolarizing muscle relaxant on BIS.

    Measured: Three years

  20. The effect of patient temperature on BIS.

    Measured: Three years

  21. Incidence of recall of traveling to the OR among patients who receive midazolam in the holding area and whose initial BIS reading in the OR is > 60.

    Measured: Three years

  22. Relationship between BIS, ETAG and EEG parameters.

    Measured: Three years

  23. Annual assessment of practitioners' abilities to interpret BIS tracings and to identify artefacts.

    Measured: Three years

  24. Differences in anesthesia practice among four institutions in the USA and Canada as judged by anesthetic doses and BIS readings.

    Measured: Three years

  25. Effect of BIS and ETAG protocols on anesthetic dose administration and on BIS readings.

    Measured: Three years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 May 2008 (estimated)
  2. Study startMar 2008
  3. Primary completionDec 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
6,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00682825
Sponsor's protocol ID
07-1253
Acronym
BAG-RECALL
Status last verified
Jan 2011
First submitted
16 May 2008
Last updated
4 Jan 2011
Results posted
No
Data monitoring committee
Yes

Publications

  • Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004 May 29;363(9423):1757-63. doi: 10.1016/S0140-6736(04)16300-9.

    PubMed 15172773
  • Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med. 2008 Mar 13;358(11):1097-108. doi: 10.1056/NEJMoa0707361.

    PubMed 18337600
  • Avidan MS, Palanca BJ, Glick D, Jacobsohn E, Villafranca A, O'Connor M, Mashour GA; BAG-RECALL Study Group. Protocol for the BAG-RECALL clinical trial: a prospective, multi-center, randomized, controlled trial to determine whether a bispectral index-guided protocol is superior to an anesthesia gas-guided protocol in reducing intraoperative awareness with explicit recall in high risk surgical patients. BMC Anesthesiol. 2009 Nov 30;9:8. doi: 10.1186/1471-2253-9-8.

    PubMed 19948045
  • Mashour GA, Tremper KK, Avidan MS. Protocol for the "Michigan Awareness Control Study": A prospective, randomized, controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of intraoperative awareness. BMC Anesthesiol. 2009 Nov 5;9:7. doi: 10.1186/1471-2253-9-7.

    PubMed 19891771
  • Mashour GA, Esaki RK, Tremper KK, Glick DB, O'Connor M, Avidan MS. A novel classification instrument for intraoperative awareness events. Anesth Analg. 2010 Mar 1;110(3):813-5. doi: 10.1213/ANE.0b013e3181b6267d. Epub 2009 Aug 27.

    PubMed 19713251
  • Willingham M, Ben Abdallah A, Gradwohl S, Helsten D, Lin N, Villafranca A, Jacobsohn E, Avidan M, Kaiser H. Association between intraoperative electroencephalographic suppression and postoperative mortality. Br J Anaesth. 2014 Dec;113(6):1001-8. doi: 10.1093/bja/aeu105. Epub 2014 May 22.

    PubMed 24852500
  • Whitlock EL, Torres BA, Lin N, Helsten DL, Nadelson MR, Mashour GA, Avidan MS. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg. 2014 Apr;118(4):809-17. doi: 10.1213/ANE.0000000000000028.

    PubMed 24413548
  • Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, Karl L, Kamal S, Torres B, O'Connor M, Evers AS, Gradwohl S, Lin N, Palanca BJ, Mashour GA; BAG-RECALL Research Group. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011 Aug 18;365(7):591-600. doi: 10.1056/NEJMoa1100403.

    PubMed 21848460

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Bispectral index protocol and End tidal anesthetic gas-guided in people with Explicit Recall of Intra-Operative Events, run by Washington University School of Medicine at 3 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Jan 2011. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The incidence of explicit recall of events during the surgical and anesthetic periods. (time frame: Three years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00682825, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Jan 2011.

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