The Effect of Repetitive Transcranial Magnetic Stimulation (rTMS) on Perioperative Neurocognitive Disorders in Patients after Cardiac Surgery: Study Protocol for a Randomized Controlled Trial

Introduction : Perioperative neurocognitive disorders(PND)is one of the most common postoperative complications among elderly patients (above 65 years old) undergoing cardiac surgery. However, thus far, there have not been any effective therapies for managing PND. Recent research has shown that repetitive transcranial magnetic stimulation (rTMS) alters brain plasticity and improves cognitive function in several neurodegenerative disorders and psychiatric disorders. However, the potential benefits of rTMS in reducing PND in patients undergoing cardiac surgery have not been investigated. Therefore, the current protocol is designed to determine whether rTMS can reduce the incidence of PND in patients undergoing cardiac surgery. Methods and analysis : The study will be a single-blinded, randomized controlled trial. Participants undergoing elective cardiac surgery will be randomized to receive either rTMS or sham stimulation with a focal figure of eight coils over the right dorsolateral prefrontal cortex. A series of neuropsychological tests will be completed to evaluate cognitive function in surgery patients before, on day 7, and on day 30 after cardiac surgery. The primary outcome is the prevalence of PND in cardiac surgery patients. The secondary outcomes will be the incidence of postoperative delirium, pain, sleep quality, depressive symptoms, activities of daily living, length of hospital stay and ICU length of stay, and rate of complication and mortality during the hospital stay. Ethics and dissemination : Beijing Chaoyang Hospital Ethics Committee approved this study and has number 2022-ke-487. It is registered with Clinical Trials (trial number NCT 05668559). Informed consent must be provided by all participants. The study result will be published in a peer-reviewed journal. Trial registration number : NCT05668559