Projects and Grants
Elder Surgery - Functional Recovery Following Beta Blockade - 5R01AG018772
The objective of this multicentered clinical trial is to evaluate the impact of anesthetic-coupled intra-operative beta-blockade on long term functional recovery in elders undergoing elective major abdominal surgery. The proposed research is a five-year randomized partial open-label trial of approximately 1100 patients 65 years of age or older having elective major abdominal surgery. Eligible patients will be divided into two groups: those currently receiving chronic beta-blockade or possessing risk factors for myocardial ischemia will be assigned to receive beta-blockers before and after surgery, those without risk factors will not. Within each group, eligible patients will be randomized to receive either a control anesthetic or anesthetic-coupled intra-operative beta-blockade. Patients will be evaluated preoperatively and postoperatively using a broad battery of functional and performance measures. Postoperative evaluations will take place over three stages: Stage 1 - end of surgery to discharge from the Post-Anesthesia Care Unit; Stage 2 - end of PACU stay through postoperative day three; and Stage 3 - postoperatively at one, three, and six weeks and three and six months. The impact of the intra-operative intervention will be assessed by pursuing the following specific aims:
- comparison of the time course and extent of long-term (stage 3) functional recovery in elderly surgical patients receiving either a control or an anesthetic-coupled beta-blockade regimen;
- comparison of the course of early (stage 1 and 2) recovery with particular reference to postoperative pain and analgesic medications in elderly surgical patients receiving either a control or an anesthetic-coupled beta-blockade regimen, and;
- evaluation of the correlation between cardiac troponin release and cardiovascular outcome for six months following operation in elderly surgical patients receiving either a control or an anesthetic-coupled beta-blockade regimen.
Perioperative Cognitive Protection - Dexmedetomidine and Cognitive Reserve.
This grant is currently in pilot trial with a submission to the NIH pending. The hypothesis is that the alpha 2 agonist dexmedetomidine, by the provision of analgesia and sedation, will decrease the incidence of delirium in elderly surgical patients