- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02799589
Remifentanil-dexmedetomidine Anesthesia With a Caudal for Elective Surgery. (Remi-dex) (Remi-dex)
Remifentanil-dexmedetomidine Anesthesia as an Alternative Anesthetic for Elective Pediatric Surgery: a Pilot Study.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In light of the concern for potential anesthetic neurotoxicity in infants and toddlers, it is prudent to start investigating alternative methods to decrease the amount of volatile anesthetic being utilized in this patient population. The US Food and Drug Administration has been asked to evaluate the data showing the neurotoxic effects of multiple anesthetic agents in animal models and humans. These studies have shown that N-methyl-D-aspartate (NMDA) receptor blockers such as ketamine,and gamma-Aminobutyric acid receptor (GABA) modulators like benzodiazepines, nitrous, propofol, barbiturates and isoflurane have been shown to cause brain cell apoptosis in animal models.
Regional anesthesia provides both intraoperative and postoperative analgesia may play a major role in effectively reducing the amount of general anesthetic used. Caudal anesthesia has been proven be both safe, effective and is applied widely in the pediatric population.
Dexmedetomidine is a selective alpha2-adrenergic agonist that acts in the brainstem by inhibiting norepinephrine release. Dexmedetomidine is commonly used off-label, including use for duration greater than 24 hours and any use in pediatrics. Dexmedetomidine has relatively few adverse events when compared to other sedative agents, with hypotension and bradycardia being most common.
Remifentanil has a rapid onset, rapid offset, small volume of distribution, rapid clearance, and a short elimination half-life, It may be a useful anesthetic for pediatric outpatient surgery.
While the current standard of care involves a volatile general anesthetic with a caudal block, anesthesiologists have alternative methods that can be utilized to allow an elective surgery to be performed. In summary, this study intends to show the efficacy and safety of a remifentanil-dexmedetomidine infusion and caudal block for patients ages 1 year-3 years old receiving elective circumcision, hydrocele repair, orchidopexy, mild hypospadias or inguinal hernia repair. This alternative anesthetic is already being studied in children under 12 months.
Study Type
Phase
- Phase 4
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Children aged 1 - 3 years undergoing urologic surgery (circumcision, hydrocele repair, orchidopexy, mild hypospadias) or inguinal hernia repair
- American Society of Anesthesiologist Physical Status (ASA-PS) I or II
- Eligible for caudal block
- Parental/legal guardian consents for study '
Exclusion Criteria:
- Allergy to remifentanil, dexmedetomidine or ropivacaine
- Family history of malignant hyperthermia
- Parental/legal guardian refusal
- ASA-PS ≥ 3
- Symptoms of upper respiratory infection (URI) within the 2 weeks prior to surgery
- Known spinal deformity, presence of sacral dimple, or signs of infection at the site of the caudal block (e.g. diaper rash, skin redness or tenderness).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Remifentanil-dexmedetomidine and caudal
Anesthesia will be induced with inhaled sevoflurane which will be discontinued once IV access is obtained and the airway is secured with an endotracheal tube.
Patients will receive remifentanil loading dose of 1mcg/kg over 1 min followed by an infusion (0.05-0.5 mcg/kg/min) and dexmedetomidine load at 1mcg/kg over 10 mins followed by and infusion (0.2-0.7 mcg/kg/hr) A caudal block with 0.2% ropivacaine will be performed in all patients for intraoperative and postoperative pain control.
|
1mcg/kg over 1 min followed by an infusion (0.05-0.5 mcg/kg/min)
Other Names:
1mcg/kg over 10 mins followed by and infusion (0.2-0.7 mcg/kg/hr)
Other Names:
Caudal anesthesia block with Ropivicaine 0.2% 1ml/kg injected into the caudal space
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients requiring intervention for light anesthesia
Time Frame: 90-120 mins (length of surgery)
|
Identified by patient movement, change in mean arterial pressure >80 at surgical incision, need to change anesthetic plan
|
90-120 mins (length of surgery)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to recovery after anesthesia
Time Frame: 10 mins; 1- 4 hours
|
Time from end of surgery to: extubation; time to discharge from post-anesthesia care unit (PACU)
|
10 mins; 1- 4 hours
|
Number of patients requiring rescue analgesia in PACU
Time Frame: 30 mins to 4 hours after surgery
|
Use of Fentanyl, Morphine, Ketorolac in recovery unit,
|
30 mins to 4 hours after surgery
|
Number of patients with pain after surgery
Time Frame: 1 to 4 hours
|
Pain is assessed after recovery on Face, Legs, Activity, Cry, Consolability (FLACC) scale 0 to 10.
Average score will be noted.
|
1 to 4 hours
|
Number of patients with respiratory event
Time Frame: Anesthesia start to discharge from PACU usually 2- 6 hours
|
Bronchospasm, laryngospasm and pulse oximetry desaturation to less than 90%
|
Anesthesia start to discharge from PACU usually 2- 6 hours
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Mofya Diallo, MD, Children's National Health System
Study record dates
Study Major Dates
Study Start (Anticipated)
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- 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
- Anesthetics
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Analgesics, Opioid
- Narcotics
- Hypnotics and Sedatives
- Anesthetics, Local
- Remifentanil
- Dexmedetomidine
- Ropivacaine
Other Study ID Numbers
- Pro00006472
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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