Comparison of Bispectral Index Values in Patients With and Without Down’s Syndrome

Overview

About 1 in every 700 babies born in the United States has Down's Syndrome (DS; Trisomy 21), 99% of whom have some degree of intellectual disability. Recent advances in medicine have resulted in a dramatically improved lifespan of about 25 to 60 years of age. Yet, there is limited data about anesthetic management in this increasing patient population. The bispectral index (BIS) monitor is a non-invasive monitoring device that reports a value between 0 and 100correlating to level of consciousness of an individual. A value of 0 indicates lack of brain activity while 100 indicates an awake/alert state. This monitor can be used to assess the depth of anesthesia. Patients with intellectual disability from congenital neurological diseases have lower BIS values compared to patients without any neurological impairment (Valkenburg 2009). The results may suggest that DS patients would require less anesthetic drugs compared to patients without any neurological impairment. To date, there are no studies in DS patients.

Full Title of Study: “Comparison of Bispectral Index Values in Patients With and Without Down’s Syndrome”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: July 13, 2017

Detailed Description

Based on the Valkenburg group's study (2009), one might hypothesize that if the BIS value is fixed for all patients, then a patient with an intellectual disability such as a patient with DS would require less anesthetic drugs compared to a control patient without any neurological disability. However, if one is only using a clinical sedation scale, the DS patient may receive more anesthetic drugs in order to achieve the same level of clinical unconsciousness as a patient without DS. This project seeks to elucidate the effect of anesthetic techniques and agents on patients with DS compared to those without DS and any intellectual disability. The goal of this project is to compare BIS values in patients with DS to those without DS undergoing a standardized general anesthetic technique. The investigators hypothesize that patients with DS would have lower (>25%) BIS values compared to those without DS. Known potential sources of artifact signals that could change BIS values include electromyographic activity, electric devices, hypothermia, hypoglycemia, and the timing and type of anesthetics used (Duarte 2009, Dahaba 2005). These potential sources will be identified and reported during the study, and those patients will be excluded from the study

Interventions

  • Device: monitoring BIS in both groups
    • We will be monitoring BIS in both groups. A BIS monitor may be placed prior to induction or immmeditaely afterwards for monitoring BIS. All patients will receive general anesthesia. A standard inhalation induction agent such as sevoflurane and oxygen will be administered via face mask with or without an oral airway. An inhalation agent will be administered for the duration of the procedure. The MAC goal for inhalation agents will be 1. If the patient moves, the MAC goal will be increased to 1.5 and this change will be recorded.

Arms, Groups and Cohorts

  • Normal
    • This is the group with no neurological problems or syndrome
  • Down syndrome
    • This is the group with Down syndrome

Clinical Trial Outcome Measures

Primary Measures

  • measure BIS values in the normal patients and those with Down syndrome under anesthesia
    • Time Frame: 2 years
    • >25% lower BIS values in patients with DS compared to patients without DS

Participating in This Clinical Trial

Inclusion Criteria

  • • Patients with DS and those without DS receiving BIS monitoring – Children between the ages of 2 and 17 years old (inclusive) – Patients scheduled for unilateral or bilateral tympanostomy (ear tube placement) at Penn State Hershey Medical Center – Patients with American Society of Anesthesiologists (ASA) physical status I, II and III – Eligible for standard general anesthesia technique protocol as determined by anesthesia provider(s) Exclusion Criteria:

  • Patients with congenital diseases/anomalies except Down's Syndrome – Patients with myotonic dystrophies or other neurodegenerative diseases – Patients with cerebrovascular accidents (strokes) – Patients not receiving BIS monitoring – Pregnant patients – Patients with allergic skin reactions to electrode patches – Patients 18 years of age and greater

Gender Eligibility: All

Minimum Age: 2 Years

Maximum Age: 17 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Milton S. Hershey Medical Center
  • Provider of Information About this Clinical Study
    • Principal Investigator: Priti G. Dalal, Associate Professor – Milton S. Hershey Medical Center

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.