- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00409344
Dexmedetomidine for Postoperative Sedation in Patients Undergoing Repair of Thoracoabdominal Aortic Aneurysms
Phase 4 Study of Dexmedetomidine for Postoperative Sedation in Patients Undergoing Repair of Thoracoabdominal Aortic Aneurysms
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Repair of thoraco-abdominal aortic aneurysms (TAA) is mostly performed in specialized centers. These centers report an operative mortality around 10%. In an analysis of 337 consecutive TAA, Cambria et al reported pulmonary (44%), cardiac, (13.8 %) renal (13.5%) and postoperative spinal cord deficit as prominent complications. Due to the extent of the surgery and the high risk of complications, all these patients require post- operative care in the Intensive Care Unit (ICU). In 2003, the operation was performed in approximately 40 patients at the Massachusetts General Hospital (MGH). The median length of stay in the ICU was 7 days (range 2-55) All patients required postoperative mechanical ventilation for greater than 48 h. During this period, a continuous intravenous infusion of propofol is normally used for sedation. Pain relief is provided by a continuous intravenous infusion of hydromorphone. This combination of sedation and analgesia is widely used at MGH and other institutions. Although very effective, it may cause respiratory depression and a deep sedative state, which may result in a prolonged requirement for mechanical ventilation. Lighter or more controllable sedation appears to be beneficial in this regard: daily wake up of intubated and sedated ICU patients decreases days on the ventilator and length of stay in the ICU.
Dexmedetomidine is a highly specific α2 agonist with prominent central nervous system (CNS) and cardiovascular effects It is FDA-approved as a postoperative sedative-hypnotic agent for intensive care patients for use up to 24 hours. The drug has hypnotic, sedative, analgesic and anxiolytic actions, and it tends to cause a mild decrease in blood pressure and heart rate. Patients or healthy volunteers sedated with dexmedetomidine alone are easily arousable and have no apparent respiratory depression. Dexmedetomidine has synergistic hypnotic and analgesic interactions with virtually all CNS depressants tested. It significantly decreases sedative and opioid requirements during and after major surgical procedures.Other potentially beneficial effects that are not as well-documented include bronchodilation and the ability to induce a more 'physiologic' sleep than other hypnotics commonly used in the ICU. Dexmedetomidine sedation may also be associated with a lower incidence of delirium.
Patients recovering from TAA surgery routinely require substantial ICU resources. If dexmedetomidine decreases the opioid and sedative requirement in these patients, it may potentially decrease the average number of days spent on the ventilator and in the ICU.
Study Type
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02114
- Massachusetts General Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All Patients over age 18 undergoing non-emergent repair of type I-III TAA
Exclusion Criteria:
- Pregnancy
- Patients with hepatic impairment (increase of ALT or AST three times normal)
- Patient taking clonidine or tricyclic antidepressants.
- Patients taking opioids or benzodiazepines chronically (> 2 doses a day for > 1 month)
- Patients with second or third degree heart block without a pacer
- Patients undergoing emergency repair of TAA
- Intraoperative cardiac arrest
- Intraoperative massive blood loss (>10 l)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: SINGLE_GROUP
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
PLACEBO_COMPARATOR: 1
Normal Saline
|
Normal Saline will be given as the placebo and will administered at 0.8mcg/kg/hr
Other Names:
|
ACTIVE_COMPARATOR: Dexmedetomidine
Dexmedetomidine is a highly specific a2 agonist with prominent central nervous system and cardiovascular effects.
A postoperative sedative-hypnotic agent for intensive care patients for use up to 24 hours.
|
Normal Saline will be given as the placebo and will administered at 0.8mcg/kg/hr
Other Names:
A continuous infusion of dexmedetomidine will be started at a dose of 0.8mcg/kg/hr.
This will continue for no longer than 24 hours.
Four hours post extubation the study drug wii be discontinued using a standard tapering protocol: 0.6mcg/kg/hr for 4 hours then 0.4mcg/kg/hr for 4 hours, then 0.2 mcg/kg/hr for 4 hours and then 0.1mcg/kg/hr for 4 hours and then turned off.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to a Successful Spontaneous Breathing Trial.
Time Frame: 1/1/2008
|
Did not achieve this primary outcome due to no enrollment of participants.
Unable to measure this outcome.
|
1/1/2008
|
Intensive Care Unit Length of Stay
Time Frame: 1/1/2008
|
The number of days each patient was in the Intensive Care Unit.
Unable to measure this outcome due to no enrollment of participnats.
|
1/1/2008
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Secondary Endpoints Include:Amount of Sedative and Opiates Given
Time Frame: 1/1/2008
|
Did not achieve this outcome due to no enrollment of participants
|
1/1/2008
|
Time to Extubation
Time Frame: 1/1/2008
|
Did not achieve this outcome due to no enrollment of participants
|
1/1/2008
|
Amount of Vasoactive Substances Used to Achieve Hemodynamic Stability
Time Frame: 1/1/2008
|
Did not achieve this outcome due to no enrollment of participants, unable to measure this outcome
|
1/1/2008
|
Pharmaco-economics
Time Frame: 1/1/2008
|
Did not achieve this outcome due to no enrollment of participants
|
1/1/2008
|
Incidence of Delirium; Number of Shifts During Which Delirium Was Diagnosed
Time Frame: 1/1/2008
|
Did not achieve this outcome due to no enrollment of participants.
Was unable to measure this outcome.
|
1/1/2008
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Ulrich Schmidt, MD,PhD, Massachusetts General Hospital
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Aortic Diseases
- Aneurysm
- Aortic Aneurysm
- Aortic Aneurysm, Thoracic
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Hypnotics and Sedatives
- Dexmedetomidine
Other Study ID Numbers
- 2006-P-001827
- IND:74068
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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