- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02515019
Bispectral Index Guided Sevoflurane Titration
Bispectral Index Guided Titration of Sevoflurane in On-pump Cardiac Surgery Reduces Plasma Sevoflurane Concentration and Vasopressor Requirements
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Electroencephalographic (EEG)-based monitoring systems, for example the bispectral index [(BIS); BIS monitor, Covidien, Boulder, Colorado, USA], were designed to prevent anaesthesia underdosage with the risk of awareness and to reduce the time to awakening after terminating general anaesthesia. However, little is known about the consequences of anaesthetic overdose. The investigators assume that high doses of anaesthetics result in cardiocirculatory depression and the necessity for high-dose vasopressor therapy, followed by microcirculation disorder and organ dysfunction.
The investigators hypothesised that in on-pump cardiac-surgery, goaldirected administration of sevoflurane guided by BIS monitoring reduces excessive sevoflurane plasma concentration (SPC) and the need for an intraoperative vasopressor. To test this hypothesis, the current study compared BIS-guided sevoflurane administration with the constant delivery of an inspired sevoflurane concentration of 1.8% during on-pump cardiac surgery and analysed its effect on the SPC and the required intraoperative dosage of norepinephrine.
The study population was divided into two patient groups: Thirty-three on-pump cardiac surgery patients enrolled in the study were allocated to a conventionally treated control group, with the constant administration of an inspired concentration of sevoflurane 1.8% (group Sevo1.8%). Thirty-four patients were sequentially allocated to an interventional group with BIS-guided administration of sevoflurane (group SevoBIS).
Vasoactive drugs were administered according to the following protocol in both groups. If the mean arterial blood pressure decreased below 50 mmHg, a continuous infusion of norepinephrine was given to maintain a perfusion pressure between 50 and 60 mmHg during cardiopulmonary bypass. If the mean arterial pressure increased above 75 mmHg, nitroglycerine was used in boluses of 0.1 mg until arterial pressure returned to a mean of less than 75 mmHg. If mean arterial pressure persisted above 75 mmHg after a cumulative administration of nitroglycerine 1.0 mg, urapidil was administered in boluses of 0.1 mg/kg until the perfusion pressure decreased below 75 mmHg.
At the end of the surgical procedure, all patients were transferred to the ICU.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Hamburg, Germany, 20246
- Department of Anesthesiology; Center of Anesthesiology and Intensive Care Medicine, Hamburg Eppendorf University Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Undergoing elective on-pump cardiac surgery and an American Society of Anesthesiologists' (ASA) physical status of 3 to 4
Exclusion Criteria:
- A contraindication to the administration of volatile anaesthetics, an active infection with a temperature more than 38°C and any history of neurological disease
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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No Intervention: Group Sevo1.8%
Anaesthesia was maintained with a constant inspired concentration of sevoflurane 1.8% (Sevorane; Abbvie, Wiesbaden, Germany) administered via the ventilator.
From the beginning of CPB, a constant flow of sevoflurane 1.8% was administered with the oxygenator fresh-gas supply, using a common anaesthetic vaporiser (Draeger Vapor Version 2000; Draeger, Luebeck, Germany).
Following successful weaning from CPB, sevoflurane was again administered at an inspired concentration of 1.8% using the ventilator.
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Experimental: Bispectral index Monitoring
The sevoflurane concentration via the ventilator and the oxygenator fresh gas supply was titrated to maintain a target BIS value between 40 and 60 (BIS-Monitor, Covidien, Boulder, Colorado, USA).
However, the concentration of sevoflurane in the oxygenator fresh gas supply was not reduced below 0.3%.
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In group SevoBIS, the sevoflurane concentration was titrated to maintain a target BIS value between 40 and 60.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
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Cumulative intraoperative administration of norepinephrine
Time Frame: During operation
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During operation
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
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Sevoflurane concentration in the oxygenator freshgas supply during cardiopulmonary bypass
Time Frame: During operation
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During operation
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Postoperative blood lactate concentration
Time Frame: Upon arrival in the intensive care unit (ICU)
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Upon arrival in the intensive care unit (ICU)
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Duration of postoperative mechanical ventilation
Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 2 weeks
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Participants will be followed for the duration of hospital stay, an expected average of 2 weeks
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ICU length of stay
Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 2 weeks
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Participants will be followed for the duration of hospital stay, an expected average of 2 weeks
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Incidence of acute kidney injury
Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 2 weeks
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Participants will be followed for the duration of hospital stay, an expected average of 2 weeks
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Sevoflurane Plasma Concentration during CPB
Time Frame: During operation
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During operation
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Collaborators and Investigators
Investigators
- Study Chair: Christian Zoellner, Professor, Department of Anesthesiology; Center of Anesthesiology and Intensive Care Medicine, Hamburg Eppendorf University Medical Center
Publications and helpful links
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Sevo_2_2014
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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