临床试验公共管理平台 Clinical Trial Management Public Platform

Screening
Baseline
Follow-up 1
Follow-up 2
Follow-up 3
Conclusion of the research

1.Screening

Management for Progress
Inclusion Criteria
Exclusion Criteria
The group record

1.Management for Progress

2.Inclusion Criteria

All of the following items should be met (except the control group):	Age between 6-12 / had scheduled non-major surgery under general anesthesia (ASA grade 1-2)

All of the following items should be met (except the control group):

Age between 6-12

had scheduled non-major surgery under general anesthesia (ASA grade 1-2)

3.Exclusion Criteria

Any meet one of the following items or more should be excluded:

Any meet one of the following items or more should be excluded:

4.The group record

Written informed consent was obtained from all participants’ guardians. All the participants meet the inclusion criteria and are not accordance to the exclusion criteria. They are divided into different groups according the anesthesia duration.
Group	long-duration

Written informed consent was obtained from all participants’ guardians. All the participants meet the inclusion criteria and are not accordance to the exclusion criteria. They are divided into different groups according the anesthesia duration.

Group

long-duration

2.Baseline

Educational level of parents	High school
Was the child born born full-term?	Yes
Age	9
The scores of the IQ test (RSPM test) 1 day before the surgery	119
Signature of the doctor
Date	2014/06/08

3.Follow-up 1

Do the participants meet any of the following eliminiation criteria and are not allowed to participant in IQ test？	The disease or symptoms listed in the exclusion criteria appear
The scores of the IQ test (RSPM test) 1 month after the surgery
Signature of the doctor
Date

4.Follow-up 2

Do the participants meet any of the following eliminiation criteria and are not allowed to participant in IQ test？
The scores of the IQ test (RSPM test) 3 months after the surgery
Signature of the doctor
Date

5.Follow-up 3

Do the participants meet any of the following eliminiation criteria and are not allowed to participant in IQ test？
The scores of the IQ test (RSPM test) 1 year after the surgery
Signature of the doctor
Date

6.Conclusion of the research

Declaration from the research director
Declaration from the database administrator

1.Declaration from the research director

I have reviewed all the data and content in this case report form. After the verification, the information record of this study is completed and is in conformity with the requirements of the test program.
Signature

2.Declaration from the database administrator

I guarantee that all the data recorded is authentic and the items are completed, which meet the requirments of the study plan.
Signature