Neuroprotection With Dexmedetomidine in Patients Undergoing Elective Cardiac or Abdominal Surgery (Neuprodex)
Neuroprotection With Dexmedetomidine in Patients Undergoing Elective Cardiac or Abdominal Surgery (Neuprodex)
The drug Dexmedetomidine will be investigated in 72 patients (men and women) undergoing
 elective cardiac or abdominal surgery. The study medication will be administered
 perioperatively by intravenous infusion continuously (at the longest 48 h) to prevent/reduce
 the rate of Delirium and the incidence of postoperative cognitive deficit (POCD).

 A non-surgical control group of 15 ASA II/III- patients from Berlin and surrounding area is
 collected for measuring the learning experience during the cognitive testings. The
 participants are matched on age, education, and gender to the study patients.

 Cognitive testings are performed in patients of the study group (n= 72) and the control group
 (n= 15) to evaluate deficits in their cognitive areas (POCD (Postoperative cognitive
 deficit)) at three different time points up to three months.
Study Group:

 Inclusion Criteria:

 1. Patients aged ≥ 60 years

 2. Male and female patients undergoing elective cardiac (elective CABG-surgery without
 valve surgery with left ventricular ejection fraction ≥ 30%) or pancreatic or hepatic
 or gastric or intestinal surgery of both Campus Charité Mitte and Campus Virchow -
 Klinikum, Charité - Universitätsmedizin Berlin

 3. Offered patient information and written consent by the patient (according to German
 Drug Law § 40 (1) 3b)

 4. Premedication only with benzodiazepines

 5. Pain therapy during the operation with regional procedures and/or Sufentanil/Fentanyl

 6. Anesthesia in cardio surgery according to Heart-Lung-Apparatus

 7. Anesthesia with hypnotic agent Propofol

 8. Pain therapy after operation according to S3-Guideline

 9. Postoperative medication for anxiolysis only with benzodiazepines

 Exclusion Criteria:

 1. Known drug intolerance/allergy: dexmedetomidine or to other ingredients

 2. Lacking willingness to save and hand out pseudonymised data within the clinical trial

 3. Accommodation in an institution due to an official or judicial order (according to AMG
 §40 (1) 4)

 4. Employee of the Charité - Universitätsmedizin Berlin CVK/CCM

 5. Illiteracy

 6. Inability to speak and/or read German

 7. Minimal mental status examination (MMSE) < 24

 8. Severe hearing loss or visual impairment

 9. Acute brain injury

 10. Intracranial haemorrhage within one year before participation in the study

 11. Manifest psychiatric disease

 12. Known illicit substance abuse

 13. Acute intoxication

 14. For women: Pregnancy or positive pregnancy test within the preoperative screening

 15. Homeless or other circumstances, where the patient would not be reachable by telephone
 or postal services for the 3-months follow up

 16. Participation in another interventional clinical trial according to the German Drug
 Law at time of inclusion and during the trial

 17. Acute circulatory failure at time of randomisation (severe hypotension with mean
 arterial pressure < 55 mmHg despite vasopressors or optimal preload)

 18. AV-conduction-block II or III (unless pacemaker installed)

 19. Severe bradycardia (heart-rate < 50 bpm, preoperative, permanent)

 20. Spinal cord injury with known autonomic dysregulation

 21. Preoperative acute cerebrovascular event with neurologic residues

 22. Liver insufficiency (Child C cirrhosis, MELD Score > 17)

 23. Application of Remifentanil during the operation

 24. Deep sedation (RASS, -4 to -5)

 25. Administration of Clonidine during administration of the study drug

 26. Additional administration of Dexmedetomidine within 3 months after study inclusion

 Control Group:

 Inclusion Criteria:

 1. Patients aged ≥ 60 years of European descent (Caucasian)

 2. Male or female patients with ASA II+III

 3. ASA II+III-patients, for which no operation is planned within the next year

 4. No operation in the last half year before study inclusion

 5. Offered patient information and written informed consent

 Exclusion Criteria

 1. Minimal mental status examination (MMSE) < 24

 2. Missing informed consent for saving and hand out pseudonymous data

 3. Neuropsychiatric morbidity, which limits the conduction of the neurocognitive testing

 4. Anacusis or Hypoacusis, which limits the conduction of the neurocognitive testing

 5. Taking psychothropic drugs (including sleep-inducing drug and benzodiazepine) on a
 regular basis and other substances, which limit the conduction of the neurocognitive
 testing