- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02399397
Influence of Age, Sepsis and SLCO1A2 Polymorphisms on Rocuronium Pharmacokinetics (ROCSEPSIS)
January 24, 2017 updated by: Natalia Valadares de Moraes, Universidade Estadual Paulista Júlio de Mesquita Filho
Influence of Sepsis, Age and SLCO1A2 Genetic Polymorphisms on Rocuronium Pharmacokinetics-pharmacodynamics in ASA I-III Surgical Patients
This study aims to evaluate the influence of age and sepsis on in vivo activity of OATP1A2 using rocuronium (ROC) as a probe and evaluating the pharmacokinetics and pharmacodynamics in ASA I-III surgical patients.
Thus, adult patients without sepsis (control group, n= 12), adult patients with sepsis (sepsis group, n= 12) and elderly patients without sepsis (elderly group, n= 12), all submitted to small to medium-sized surgeries who were induced with individual doses of rocuronium, fentanyl and propofol are being investigated.
Study Overview
Status
Completed
Detailed Description
Rocuronium (ROC), a neuromuscular blocking agent used in surgical procedures, is primarily eliminated by biliary excretion.
Its distribution to the liver, mediated the organic anion transporting polypeptide 1A2 (OATP1A2), is a determining factor for the duration of neuromuscular blockade.
Age and release of cytokines during inflammation and infection processes of sepsis can alter expression of SLCO1A2 gene, encoding OATP1A2.
The objective of this study is to evaluate the influence of age and sepsis on in vivo activity of OATP1A2 using ROC as a probe and evaluating the pharmacokinetics and pharmacodynamics in ASA I-III surgical patients.
Adult patients without sepsis (control group, n=12), adult patients with sepsis (sepsis group, n=12) and elderly patients without sepsis (elderly group, n=12), all submitted to small to medium-sized surgeries are being investigated.
All patients are being induced with individual doses of rocuronium, fentanyl and propofol.
Serial blood samples are being collected up to 360 minutes after administration of ROC.
Neuromuscular blockade induced by ROC is monitored by stimulation of the adductor muscle of the thumb on the ulnar nerve through the train of four monitoring (TOF) at the same times of blood sampling.
The plasma concentration of ROC will be analyzed by liquid chromatography coupled to mass spectrometry with electrospray ionization using positive ion mode.
Study Type
Interventional
Enrollment (Actual)
36
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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São Paulo
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Araraquara, São Paulo, Brazil, 14801902
- Universidade Estadual Paulista Júlio de Mesquita Filho
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Adult and elderly patients, both gender.
- Patients submitted to small to medium-sized surgeries.
- Patients who were induced with individual doses of rocuronium, fentanyl and propofol.
- Patients with normal renal function (creatinine clearance > 60 mL/min).
- Patients with normal liver function.
Exclusion Criteria:
- Patients who were in use of fluoxetine, carbamazepine, aminoglycoside antibiotics, OATP1A2 inhibitors.
- Patients with gastrointestinal and liver diseases, neuromuscular disorders.
- Patients who were in chronic use of drugs which alter rocuronium effect.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Control group
Adult patients(18-50 years old) ASA I-II without sepsis submitted to small to medium sized surgery under general anesthesia are being recruited.
All patients are being induced with individualized doses of rocuronium, midazolam, propofol and fentanyl.
Serial blood sampling are being collected up to 6 h after administration of the drug for pharmacokinetic study.
Neuromuscular blockade is being monitored by stimulation of the adductor muscle of the thumb on the ulnar nerve through the train of four monitoring (TOF) at the same time as blood sampling.
All patients are being submitted to blood testing for liver and renal function (creatinine, urea, albumin, aspartate aminotransferase and alanine aminotransferase).
|
Serial blood samples are being collected at times 0, 2, 5, 10, 15, 20, 30, 60, 120, 180, 240 and 360 minutes after rocuronium administration.
Neuromuscular blockade is being evaluated at the same time of blood sampling by stimulation of the adductor muscle of the thumb on the ulnar nerve through the train of four monitoring (TOF).
Other Names:
Blood testing: urea, creatinine, aspartate aminotransferase, alanine aminotransferase, albumin, glycemia
All patients were induced with individual intravenous doses of midazolam, rocuronium, fentanyl and propofol.
Other Names:
Patients classified according American Society of Anesthesiologists (ASA) as ASA I-III and submitted to small-medium sized surgery under general anesthesia were recruited for the present investigation.
|
Experimental: Sepsis group
Adult patients (18-50 years old) ASAII and III with sepsis, systemic inflammatory response syndrome or septic shock submitted to small to medium sized surgery under general anesthesia are being recruited.
All patients are being induced with individualized doses of rocuronium, midazolam, propofol and fentanyl.
Serial blood sampling are being collected up to 6 h after administration of the drug for pharmacokinetic study.
Neuromuscular blockade is being monitored by stimulation of the adductor muscle of the thumb on the ulnar nerve through the train of four monitoring (TOF) at the same time as blood sampling.
All patients are being submitted to blood testing for liver and renal function (creatinine, urea, albumin, aspartate aminotransferase and alanine aminotransferase).
|
Serial blood samples are being collected at times 0, 2, 5, 10, 15, 20, 30, 60, 120, 180, 240 and 360 minutes after rocuronium administration.
Neuromuscular blockade is being evaluated at the same time of blood sampling by stimulation of the adductor muscle of the thumb on the ulnar nerve through the train of four monitoring (TOF).
Other Names:
Blood testing: urea, creatinine, aspartate aminotransferase, alanine aminotransferase, albumin, glycemia
All patients were induced with individual intravenous doses of midazolam, rocuronium, fentanyl and propofol.
Other Names:
Patients classified according American Society of Anesthesiologists (ASA) as ASA I-III and submitted to small-medium sized surgery under general anesthesia were recruited for the present investigation.
|
Experimental: Elderly group
Elderly patients (> 65 years old) ASA I-II without sepsis submitted to small to medium sized surgery under general anesthesia are being recruited.
All patients are being induced with individualized doses of rocuronium, midazolam, propofol and fentanyl.
Serial blood sampling are being collected up to 6 h after administration of the drug for pharmacokinetic study.
Neuromuscular blockade is being monitored by stimulation of the adductor muscle of the thumb on the ulnar nerve through the train of four monitoring (TOF) at the same time as blood sampling.
All patients are being submitted to blood testing for liver and renal function (creatinine, urea, albumin, aspartate aminotransferase and alanine aminotransferase).
|
Serial blood samples are being collected at times 0, 2, 5, 10, 15, 20, 30, 60, 120, 180, 240 and 360 minutes after rocuronium administration.
Neuromuscular blockade is being evaluated at the same time of blood sampling by stimulation of the adductor muscle of the thumb on the ulnar nerve through the train of four monitoring (TOF).
Other Names:
Blood testing: urea, creatinine, aspartate aminotransferase, alanine aminotransferase, albumin, glycemia
All patients were induced with individual intravenous doses of midazolam, rocuronium, fentanyl and propofol.
Other Names:
Patients classified according American Society of Anesthesiologists (ASA) as ASA I-III and submitted to small-medium sized surgery under general anesthesia were recruited for the present investigation.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Determination of AUC/dose
Time Frame: Up to 6h after rocuronium administration
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Determination of area under the plasma concentration versus time curve (AUC)/dose of rocuronium will be estimated for pharmacokinetic analysis.
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Up to 6h after rocuronium administration
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Determination of total clearance
Time Frame: Up to 6h after rocuronium administration
|
Determination of total clearance of rocuronium will be estimated for pharmacokinetic analysis.
|
Up to 6h after rocuronium administration
|
Determination of volume of distribution
Time Frame: Up to 6h after rocuronium administration
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Determination of volume of distribution of rocuronium will be estimated for pharmacokinetic analysis.
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Up to 6h after rocuronium administration
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Determination of mean residence time
Time Frame: Up to 6h after rocuronium administration
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Determination of mean residence time of rocuronium will be estimated for pharmacokinetic analysis.
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Up to 6h after rocuronium administration
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OATP1A2 genotyping using Real Time-PCR
Time Frame: Up to 5 minutes before rocuronium administration
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The single nucleotide polymorphisms of SLCO1A2 gene (404A>T, 559G>A, 833delA at coding sequence and -1105G>A, -1032G>A, -715T>C, -361G>A e -189_-188insA at the non-coding sequence of SLCO1A2) are being evaluated in all included patients, using Real Time PCR.
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Up to 5 minutes before rocuronium administration
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Analysis of cytokine IL-1α in plasma
Time Frame: Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Plasma cytokine Interleukin-1α (IL-1α) will be evaluated in each patient.
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Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Analysis of cytokine IL-1β in plasma
Time Frame: Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Plasma cytokine IL-1β will be evaluated in each patient.
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Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Analysis of cytokine IL-6 in plasma
Time Frame: Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Plasma cytokine IL-6 will be evaluated in each patient.
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Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Analysis of cytokine TNF-α in plasma
Time Frame: Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Plasma cytokine Tumor Necrosis Factor-α (TNF-α) will be evaluated in each patient.
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Up to 5 minutes before rocuronium administration; 30 and 360 minutes after rocuronium administration
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Pharmacokinetic-Pharmacodynamic analysis: relationship between rocuronium plasma concentration and the neuromuscular blockade
Time Frame: Up to 6h after rocuronium administration
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The relationship between rocuronium plasma concentration and the neuromuscular blockade will be described by a sigmoid maximum effect model for each patient
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Up to 6h after rocuronium administration
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Natalia V. de Moraes, Prof., Universidade Estadual Paulista Júlio de Mesquita Filho
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- de Moraes NV, Lauretti GR, Filgueira GC, Lopes BC, Lanchote VL. Analysis of rocuronium in human plasma by liquid chromatography-tandem mass spectrometry with application in clinical pharmacokinetics. J Pharm Biomed Anal. 2014 Mar;90:180-5. doi: 10.1016/j.jpba.2013.11.032. Epub 2013 Dec 7.
- Costa ACC, Coelho EB, Lanchote VL, Correia BV, Abumansur JT, Lauretti GR, de Moraes NV. The SLCO1A2 -189_-188InsA polymorphism reduces clearance of rocuronium in patients submitted to elective surgeries. Eur J Clin Pharmacol. 2017 Aug;73(8):957-963. doi: 10.1007/s00228-017-2243-1. Epub 2017 Apr 14.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
February 1, 2014
Primary Completion (Actual)
December 1, 2015
Study Completion (Actual)
December 1, 2015
Study Registration Dates
First Submitted
March 2, 2015
First Submitted That Met QC Criteria
March 20, 2015
First Posted (Estimate)
March 26, 2015
Study Record Updates
Last Update Posted (Estimate)
January 25, 2017
Last Update Submitted That Met QC Criteria
January 24, 2017
Last Verified
October 1, 2016
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Infections
- Inflammation
- Shock
- Sepsis
- Toxemia
- Systemic Inflammatory Response Syndrome
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Intravenous
- Anesthetics, General
- Analgesics, Opioid
- Narcotics
- Tranquilizing Agents
- Psychotropic Drugs
- Hypnotics and Sedatives
- Adjuvants, Anesthesia
- Anti-Anxiety Agents
- GABA Modulators
- GABA Agents
- Neuromuscular Agents
- Neuromuscular Nondepolarizing Agents
- Neuromuscular Blocking Agents
- Anesthetics
- Fentanyl
- Midazolam
- Propofol
- Rocuronium
Other Study ID Numbers
- ROC1314730-0
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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