Dexmedetomidine Supplemented Analgesia and Long-term Survival After Cancer Surgery

  • STATUS
    Recruiting
  • End date
    Apr 30, 2024
  • participants needed
    1500
  • sponsor
    Peking University First Hospital
Updated on 30 April 2022
anesthesia
cancer surgery
analgesics
analgesia
morphine
dexmedetomidine
cancer
inflammatory response
delirium
metastasis

Summary

A majority of the elderly patients undergo surgery for malignant tumors. For these patients, postoperative tumor recurrence and metastasis are main factors that worsen long-term outcomes. The investigators hypothesize that dexmedetomidine supplemented analgesia in elderly patients after cancer surgery may help to maintain immune function and improve long-term outcomes, possibly by relieving stress and inflammatory response, improving analgesic efficacy and sleep quality, and reducing delirium incidence.

Description

A majority of the elderly patients undergo surgery for malignant tumors. For these patients, postoperative tumor recurrence and metastasis are main factors that worsen the quality of life and shorten the duration of survival. Perioperative immune function is a key element that influences postoperative tumor recurrence and metastasis; but it is subject to the impacts of many factors. Studies showed that elevated cortisol level and inflammation provoked by surgical stress result in suppression of immune function, whereas dexmedetomidine alleviates the elevated cortisol level and inhibit excessive inflammation; high-dose opioids inhibit the immune function and increase the invasiveness of tumor cells, whereas dexmedetomidine reduces the consumption of opioids during perioperative period; postoperative sleep disturbances also impair immune function, whereas dexmedetomidine improves sleep quality in patients after surgery; occurrence of postoperative delirium is associated with increased mortality, whereas dexmedetomidine reduces delirium incidence. The investigators hypothesize that dexmedetomidine supplemented analgesia in elderly patients after cancer surgery may improve the long-term outcomes, possibly by relieving stress and inflammatory response, improving analgesic efficacy and sleep quality, and reducing delirium incidence.

Details
Condition Elderly, Surgery, Analgesia, Dexmedetomidine, Long-term Outcome
Treatment Dexmedetomidine supplemented morphine analgesia, Morphine analgesia
Clinical Study IdentifierNCT03012971
SponsorPeking University First Hospital
Last Modified on30 April 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Age >= 65 years, < 90 years
Scheduled to undergo surgery for primary solid organ cancer under general anesthesia, with an expected duration of surgery >=2 hours
Planned to use patient-controlled intravenous analgesia after surgery
Provide written informed consent

Exclusion Criteria

Preoperative history of schizophrenia, epilepsy, parkinsonism or myasthenia gravis
Preoperative radio- or chemotherapy
Inability to communicate in the preoperative period because of coma, profound dementia or language barrier
Preoperative obstructive sleep apnea (previously diagnosed as obstructive sleep apnea, or a STOP-Bang score >= 3)
Brain trauma or neurosurgery
Preoperative left ventricular ejection fraction < 30%, sick sinus syndrome, severe sinus bradycardia (< 50 beats per minute), or second-degree or above atrioventricular block without pacemaker
Severe hepatic dysfunction (Child-Pugh class C) or severe renal dysfunction (requirement of renal replacement therapy before surgery)
ASA classification >= IV
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