- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02701478
ANI and NoL Index Variations After Standard Nociceptive Stimulus at 0, 50, 25 % of Inhaled N2O in the Anesthetic Mixture
Assessment of the Intraoperative Analgesic Effect of 50%/50% N2O/O2 Inhalation by the Pain Index ANI Following a Standardized Electrical Stimulus in Patients Under Anesthesia. Comparison to the New NoL Analgesic Index.
Study Overview
Detailed Description
Title: Assessment of the intraoperative analgesic effect of 50%/50% Nitrous Oxide / Oxygen inhalation by the pain index ANI following a standardized electrical forearm stimulus in patients undergoing laparotomies under general anesthesia and with an intraoperative active epidural analgesia. Comparison to the new NoL analgesic index.
Objectives: To observe the variations of the intraoperative pain indexes ANI and NoL after a classical and standardized electrical stimulation of the forearm (applied with the commonly used nerve stimulator we use for muscle relaxation monitoring) at different concentrations of inhaled Nitrous Oxide (N2O) (from 0% to 50%, concentrations that are commonly used in daily anesthesia). This will allow a quantification of the analgesic effect of N2O.
Study Design: Prospective, open label, observational and descriptive study Subject Population: Adult patients scheduled to undergo abdominal surgery by laparotomy under general anesthesia with an active intraoperative epidural analgesia Sample Size: 40 patients will be evaluated in this study Study Duration: 1 year Study Center: Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada Adverse Events: None expected
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Nadia Godin, RN
- Phone Number: 3193 514-252-3400
- Email: ngodin.hmr@ssss.gouv.qc.ca
Study Contact Backup
- Name: Philippe Richebe, MD PhD
- Phone Number: +1-514-743-6558
- Email: philipperichebe@live.com
Study Locations
-
-
Quebec
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Montreal, Quebec, Canada, H1T2M4
- Recruiting
- Hopital Maisonneuve Rosemont
-
Contact:
- Philippe Richebe, Md PhD
- Phone Number: +195140743-6558
- Email: philipperichebe@live.com
-
Contact:
- Nadia Goding, RN
- Phone Number: 3193 514-252-3400
- Email: ngodin.hmr@ssss.gouv.qc.ca
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ASA status I, II or III
- Patients aged 18 to 70 years
- Laparotomy for gynecological or bowel surgery
- Duration and type of surgery requiring an epidural analgesia via an epidural catheter placed prior the general anesthesia induction and an arterial line placed after induction of general anesthesia
Exclusion Criteria:
- When 100% O2 ventilation is required during anesthesia (except for the induction phase during which all the patients receive O2 100%).
- Patients having received intraocular injection of gas (such as SF6, C3F8, C2F6) within 3 months prior to the present surgery.
Any condition where internal entrapped air could expand and become dangerous, such as:
- head injury within 6 months prior to surgery
- maxillofacial injuries within 6 months prior to surgery
- pneumothorax within 6 months prior to surgery
- gas embolism within 6 months prior to surgery
- decompression sickness within 6 months prior to surgery
- bubbles of emphysema known for this patient
- middle ear, inner ear and sinus surgery
- major abdominal distension/occlusion and emergent surgery for intestinal obstruction
- if air has been injected into the epidural space to determine the placement of the needle for epidural anesthesia (only saline is used in our center for the loss of resistance technique to place the catheter into the epidural space)
Any contra-indication or patient's refusal for epidural placement
- Unexpected difficult airway requesting excessive, possibly painful airway manipulations.
- Unexpected surgical complications requiring strong haemodynamic support (transfusions, volume challenges, vasopressors, inotropic drugs).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: N2O exposure
There is only one arm in this study.
All patients under General Anesthesia are exposed to 4 different doses or concentrations of inhaled N2O that is combined with the anesthetic desflurane.
Each patient will be submitted to the standard nociceptive stimulus when inhaled N2O is at 0, 50, 25, and finally back to 0%.
ANI and NoL Indices variations between "before stimulus" and "after stimulus" at each N2O concentration will be assessed and compared.
This will allow to demonstrate an analgesic effect (less variations of ANI and NoL) when inhaled N2O is high (50%) testifying for the analgesic effect of this gas N2O.
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The aim of this study is to evaluate the nociceptive response to a standardized forearm electrical stimulus applied to patients under GA, during surgery, at different End-Tidal concentrations of N2O (ET-N2O: 0%-50%-25%-0%), and to see if ANI and NoL indices show less pain when inhaled N2O is higher.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ANI variation after stimulation in patients under GA at End-Tidal N2O 0% and 50%.
Time Frame: First stimulus is applied when the patient breaths 0% N2O in his anesthesia mixture. Second stimulus is applied at 50% End-Tidal N2O in the anesthesia mixture during the surgery.
|
The same patient is anesthetized without N2O in the gas mixture first.
The first standard stimulus is applied on the forearm of the patient when the N2O concentration in the anesthesia mixture is at 0%. ANI response to the stimulus is recorded.
Then N2O is slowly increased to reached et-N2O 50% in the anesthesia mixture.
Then, at ET-N2O 50%, the same standard stimulus is applied and ANI variations registered.
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First stimulus is applied when the patient breaths 0% N2O in his anesthesia mixture. Second stimulus is applied at 50% End-Tidal N2O in the anesthesia mixture during the surgery.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
NoL index variation after electrical stimulation in patients under GA atEnd-Tidal N2O 0% and 50%.
Time Frame: First stimulus is applied when the patient breaths 0% N2O in his anesthesia mixture. Second stimulus is applied at 50% End-Tidal N2O in the anesthesia mixture during the surgery.
|
The same patient is anesthetized without N2O in the gas mixture first.
The first standard stimulus is applied on the forearm of the patient when the N2O concentration in the anesthesia mixture is at 0%. NoL response to the stimulus is recorded.
Then N2O is slowly increased to reached et-N2O 50% in the anesthesia mixture.
Then, at ET-N2O 50%, the same standard stimulus is applied and NoL variations registered.
|
First stimulus is applied when the patient breaths 0% N2O in his anesthesia mixture. Second stimulus is applied at 50% End-Tidal N2O in the anesthesia mixture during the surgery.
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ANI and NoL indices variations after the same standard stimulus when ET-N2O is slowly decreased from 50% to 25%, , then to 0%.
Time Frame: Within the same anesthesia and surgery
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During the surgery, for primary and secondary objectives, N2O will be at 0, then 50%. For these secondary objectives, N2O inhaled concentration in teh anesthetic mixture will be set at 25% and then again at 0% and the same standard stimulus will be applied and ANI and NoL responses recorded and compared to the ones gotten at 50% . |
Within the same anesthesia and surgery
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Philippe Richebe, MD PhD, Maisonneuve-Rosemont Hospital
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
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
Other Study ID Numbers
- 15064
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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