Avascular Necrosis of the Femoral HeadNCT06772558
Desflurane Potentially Induces Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Perioperative Procedures by Modulating Cdc42 and Clock Proteins
A study testing Desflurane Inhalation and mechanical ventilation (MV) in people with Avascular Necrosis of the Femoral Head and Coronary Artery Disease (CAD), run by Xiaguang Duan at 1 site in China.
Trial summary
This clinical trial investigates whether desflurane induces postoperative cognitive dysfunction (POCD) in elderly patients undergoing perioperative procedures by modulating Cdc42 and Clock proteins. Read more about this study
- Who is it for?
- Ages 70 years and older
- Conditions the study is for
- Avascular Necrosis of the Femoral Head, Coronary Artery Disease (CAD), Benign Prostatic Hyperplasia (BPH)
- What is being tested?
- Desflurane Inhalation and mechanical ventilation (MV)
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteChina
- Study dates
- 1 Feb 2025to 10 May 2025
- Phase
- Interventional
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 70 years and older
- All sexes
- No healthy volunteers
- Older adult
Who may be able to join
- Age > 70 years
- American Society of Anesthesiologists (ASA) physical status classification I-III
- Scheduled to undergo elective surgery requiring general anesthesia with desflurane
- Able and willing to provide voluntary written informed consent
- Able to understand the study procedures and complete follow-up assessments
Who cannot join
- Pre-existing diagnosis of dementia or any other neurodegenerative disease that could affect cognitive function
- Preoperative Montreal Cognitive Assessment (MoCA) score < 20
- History of severe psychiatric disorders, including psychosis, severe depression, or bipolar disorder
- Unstable angina, uncontrolled hypertension, or a history of myocardial infarction within the past 6 months
- Severe chronic obstructive pulmonary disease (COPD) with significant respiratory compromise, or other significant respiratory disease
- Severe hepatic or renal impairment, defined as Child-Pugh class C for liver disease, or glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 for kidney disease
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- History of stroke, transient ischemic attack (TIA), or other significant neurological disorders
- History of alcohol or drug abuse
- Patients with visual, auditory, or language impairments that would interfere with cognitive testing.
- Known allergy or contraindication to any of the study drugs
- Other conditions at the discretion of the investigator that could interfere with the conduct of the study or the interpretation of the results
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
China1 site
Inner Mongolia Baogang Hospital
Baotou, Inner Mongolia, 014010
Xiaguang Wang, Master's degree, +86 0472 5992830, KevinDuan0901@gmail.com
About this study
Official title: The Potential Mechanism by Which Desflurane Induces Postoperative Cognitive Dysfunction in Elderly Perioperative Patients Involves the Modulation of Cdc42 and Clock Proteins, and Their Related Signaling Pathways.
This clinical trial investigates whether desflurane induces postoperative cognitive dysfunction (POCD) in elderly patients undergoing perioperative procedures by modulating Cdc42 and Clock proteins. The primary research questions are: (1) Does desflurane administration contribute to POCD in this patient population? and (2) Are alterations in Cdc42 and Clock protein levels associated with desflurane-induced POCD in elderly patients? To address these questions, elderly patients will be administered desflurane for anesthesia maintenance. Postoperative assessments will then compare blood levels of Cdc42 and Clock proteins, and examine related signaling pathways, between a control group and a POCD group.
Study participants will receive desflurane anesthesia maintained at a Bispectral Index (BIS) value of 40-60. Postoperative cognitive function will be assessed on the second day using the Montreal Cognitive Assessment (MoCA), and participants will be categorized into either a control group or a POCD group based on MoCA performance. Cognitive function and blood levels of Cdc42 and Clock proteins will be recorded. Furthermore, the study will also investigate associated signaling pathways.
Read the detailed description
Study Design:
This study is a prospective, randomized, comparative, non-inferiority clinical trial with blinding of both patients and clinicians. It investigates the non-inferiority of desflurane with respect to its impact on Cdc42 and Clock protein levels following POCD in elderly patients. Patient recruitment was conducted at Baogang Hospital, Inner Mongolia. This study received approval from the Medical Ethics Committee of Baogang Hospital, Inner Mongolia, and was performed in accordance with the Declaration of Helsinki and the Consolidated Standards of Reporting Trials (CONSORT) guidelines. All participants provided voluntary written informed consent.
Patients:
Sixty patients aged >70 years, with an American Society of Anesthesiologists (ASA) physical status of I-III, undergoing elective surgery requiring desflurane-based general anesthesia between February 2025 and May 2025, were recruited. Participants were randomly assigned to one of two groups (n=30 per group).
Randomization and Blinding:
Block randomization was employed to generate the random allocation sequence, with a block size of six. The random sequence was generated using dedicated software (the blockrand package in R version 4.3.2). Allocation of the sequence was performed by an independent third party, and allocation concealment was achieved using sequentially numbered, sealed, opaque envelopes. The research team was blinded to group allocation throughout the randomization process and was not involved in the generation or allocation of the random sequence.
Intervention:
Anesthesia was administered according to standardized institutional protocols. Patients received 1.5-2 mg/kg propofol, 1-2 mg/kg rocuronium, and 1-2 μg/kg remifentanil for induction. Anesthesia was maintained with either sevoflurane or desflurane, with inhaled concentrations adjusted based on electroencephalogram (EEG) monitoring. Remifentanil was continuously infused at 0.05-0.2 μg/kg/min, with adjustments made to maintain blood pressure and heart rate within ±20% of baseline values. Following induction, patients underwent mechanical ventilation in volume-controlled (VC) mode. Ventilation parameters were set using a GE Aestiva anesthesia machine (GE Healthcare, Waukesha, Wisconsin, USA): tidal volume 6-8 ml/kg, positive end-expiratory pressure 0 cmH2O, inspiration/expiration ratio 1:2, respiratory rate 16 breaths/min, and inspired oxygen concentration of 41%.
Outcomes and Measures:
Postoperative follow-up was conducted in the ward by two specially trained nurses who were blinded to patient allocation. Assessments were performed face-to-face at baseline and on the second postoperative day.
- Conditions
- Avascular Necrosis of the Femoral Head, Coronary Artery Disease (CAD), Benign Prostatic Hyperplasia (BPH), Cholecystitis, Knee Osteoarthritis
- Being tested
- Desflurane Inhalation, mechanical ventilation (MV)
- Medical subject headings
- Femur Head Necrosis, Coronary Artery Disease, Prostatic Hyperplasia, Cholecystitis, Osteoarthritis, Knee
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Desflurane InhalationDrug
Anesthesia was maintained with either desflurane, with inhaled concentrations adjusted based on electroencephalogram (EEG) monitoring.
mechanical ventilation (MV)Device
Following induction, patients underwent mechanical ventilation in volume-controlled (VC) mode. Ventilation parameters were set using a GE Aestiva anesthesia machine (GE Healthcare, Waukesha, Wisconsin, USA): tidal volume 6-8 ml/kg, positive end-expiratory pressure 0 cmH2O, inspiration/expiration ratio 1:2, respiratory rate 16 breaths/min, and inspired oxygen concentration of 41%.
| Study group | Role | What they receive |
|---|---|---|
| POCD group | Experimental | Postoperative cognitive dysfunction group Receives: Drug: Desflurane Inhalation; Device: mechanical ventilation (MV) |
| Control | Active comparator | No postoperative cognitive dysfunction group Receives: Drug: Desflurane Inhalation; Device: mechanical ventilation (MV) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Montreal Cognitive Assessment (MoCA)
MoCA, is a rating system from 0 to 30, where 0 represents "no postoperative cognitive dysfunction" and 30 represents the worst possible postoperative cognitive dysfunction.
Measured: At baseline (before therapy), at 2 days post-treatment
Secondary outcomes (1)
Cell division control protein 42 homolog (Cdc42) and Circadian Locomotor Output Cycles Kaput(Clock)
The normal ranges of Cdc42 and Clock were consistent with preoperative levels. The higher the value, the greater the POCD, and the worse the outcome.
Measured: At baseline (before therapy), at 2 days post-treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Jan 2025
- Study start1 Feb 2025 (estimated)
- Primary completion1 May 2025 (estimated)
- Study completion10 May 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Avascular Necrosis of the Femoral HeadStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Xiaguang Duan
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Xiaguang Duan, Inner Mongolia Baogang Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06772558
- Sponsor's protocol ID
- 2024-MER-322
- Status last verified
- Jan 2025
- First submitted
- 9 Jan 2025
- Last updated
- 14 Jan 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- Yes
- Individual data sharing
- Yes