- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03031808
Comparison of Two Induction Regimens Using Topical Lidocaine or Muscle Relaxant on Sore Throat and Hemodynamics
Comparison of Two Induction Regimens Using Topical Lidocaine or Muscle Relaxant; Impact on Postoperative Sore Throat and Haemodynamics
When a surgical procedure is performed under general anesthesia, the Airways are often secured With an endotracheal tube. Some patients experience sore throat thereafter. Studies have shown a reduction of these side effects when by use of muscle relaxants or a lidocain spray prior to the intubation. At Ostfold Hospital Trust, the investigators use one of the two methods or nothing. These methods will be studied systematically.
Heart rate and blood pressure rise during the intubation procedure. The investigators will also study the differences between the groups.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Post-operative sore throat and cough are common complications of endotracheal intubation and occurs in 30% to 70% of patients. Spraying with Lidocaine reduces this incident of postoperative sore Throat (POST). The use of neuromuscular blocking agents (NMBA) alone will also diminish the incidence of adverse postoperative upper airway symptoms. The use of topical Lidocaine is shown to reduce the cardiovascular responses during and after endotracheal intubation.
Hypertension and tachycardia as a response to endotracheal intubation are probably of little consequence in healthy individuals. These reactions might though be harmful in patients with cardiovascular diseases.
Postoperative sore throat is an undesired outcome for the patient. Topical or systemic pharmacological interventions is shown to reduce the POST.
Our anesthetists practice very different. The investigators sometime use topical lidocaine 2% as a spray, sometime muscle relaxants and often nothing but propofol and remifentanil prior to laryngoscopy an endotracheal intubation.
The objective of this study is to determine, whether the use of topical administered lidocaine, 2 %, has a better impact on POST compared with NMBA alone in general anesthesia with propofol and remifentanil. Patients receiving nothing but propofol and remifentanil will be the reference group. Assessment of the intubation conditions will be done according to a standard scheme
The primary endpoint:
- Differences in the intubation conditions between the three groups.
- Cardiovascular responses caused by the laryngoscopy and intubation.
The secondary endpoint:
• Post operative upper airways symptoms. Power and Sample Size Calculator To detect a decrease in the incidence of pharyngolaryngeal symptoms from 60% to 45%, we calculated that we needed 150 patients per study arm (power of the study, 0,8; type I error, 0,05).
450 adult patients have to be scheduled for the study.
The study is double blind, randomized:
- Group Topical lidocaine 4%:
- Group NMBA
- Control group Premedication: Paracetamol 2g General anaesthesia: TCI (Target Control of Infusion is a principle, an anesthesia infusion after protocol): Propofol and Remifentanil Surgical procedure: Not specified short lasting (<1 h) procedures The experienced anesthesiologist performing the intubating procedure will not be in the room until immediately before the intubation.
Postoperatively:
- Oral paracetamol and codeine-fixed combination up to 1000 mg and 60 mg, respectively, every 6 h
- When nausea and vomiting occurs postoperatively, ondansetron 4 mg IV administers as the drug of first choice followed by droperidol 0,625 mg IV if the nausea/vomiting persists.
Collected data:
- Patient characteristics inclusive smoke habits
- Intubation conditions according to the Copenhagen score
- Blood pressure prior to laryngoscopy and after 1, 3, 5, 7, 9, 11, 13 and 15 minutes, then every 15 min.
- Cuff pressure
- Pharyngolaryngeal discomfort 2 and 24 hours (telephone interview if released from hospital) after extubation
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Jan Sverre Vamnes, MD, Ph.D
- Phone Number: +47 913 05 016
- Email: jan.sverre.vamnes@so-hf.no
Study Contact Backup
- Name: Knut Inge Solbakk, MD
- Phone Number: +47 909 33 106
- Email: knut.inge.solbakk@so-hf.no
Study Locations
-
-
Ostfold
-
Grålum, Ostfold, Norway, 1714
- Recruiting
- Ostfold Hospital Trust, Moss
-
Contact:
- Jan Sverre Vamnes, MD, Ph.D.
- Phone Number: +47 91608896
- Email: janvam@so-hf.no
-
Contact:
- Knut Inge Solbakk, md
- Phone Number: +47 90933106
- Email: knisol@so-hf.no
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Scheduled elective surgery with general anesthesia and planned endotracheal intubation.
Exclusion Criteria:
- ASA≥3,
- 20>BMI<35
- Allergy to local anesthetics or neuromuscular blocking agents.
- The ASA physical status classification system is a system for assessing the fitness of patients before surgery. BMI is Body Mass Index measured in kilograms/square meter.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Lidocaine spray
Endotracheal lidocaine spray prior to intubation
|
Spraying trachea from 2 cm above the vocal cords and 5 cm down with a straw with multiple side holes
Other Names:
|
Other: Muscle relaxant
Muscle relaxant prior to intubation
|
After induction of anesthesia, the participants are given 0,6 mg/kg bodyweight intravenously.
Other Names:
|
Other: No Muscle relaxant, no Lidocaine
'No Muscle relaxant, no Lidocaine Control group
|
This group get general anesthesia without Rocuronium or Lidocaine
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sore Throat postoperative. Assessment of complaints and changes in complaints
Time Frame: 2 h and 24 h after extubation
|
Postoperative sore throat, described 2 h and 24 h after extubation.
If the patient has sore throat or is hoarse, the complaint is assessed on a VAS (Visual Analogue Scale) 1 - 10.
|
2 h and 24 h after extubation
|
Intubation conditions directly after induction of anesthesia
Time Frame: 90 sec. after established general anesthesia
|
Describes the intubation conditions: Jaw relaxation, resistance to laryngoscopy blade, the position and movement of vocal cords, the movement of limbs and coughing.
Each variable rates as excellent, good or poor.
Intubation conditions are many variables described once and should not be divided into several outcomes.
|
90 sec. after established general anesthesia
|
Hemodynamic parameters, change in HR (Heart Rate) is being assessed
Time Frame: Prior to induction, then every second minute the next 15 minutes, thereafter every 15 minute until end of surgery (max. 2 h.)
|
Describes changes in HR (Heart Rate)
|
Prior to induction, then every second minute the next 15 minutes, thereafter every 15 minute until end of surgery (max. 2 h.)
|
Hemodynamic parameters, change in BP (blood pressure) is being assessed
Time Frame: Prior to induction, then every second minute the next 15 minutes, thereafter every 15 minute until end of surgery (max. 2 h.)
|
Describes changes in BP(Blood Pressure)
|
Prior to induction, then every second minute the next 15 minutes, thereafter every 15 minute until end of surgery (max. 2 h.)
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Jan Sverre Vamnes, MD, Ph.D., Senior Consultant
Publications and helpful links
General Publications
- Banihashem N, Alijanpour E, Hasannasab B, Zarei A. Prophylactic Effects of Lidocaine or Beclomethasone Spray on Post-Operative Sore Throat and Cough after Orotracheal Intubation. Iran J Otorhinolaryngol. 2015 May;27(80):179-84.
- Blobner M, Mirakhur RK, Wierda JM, Wright PM, Olkkola KT, Debaene B, Pendeville P, Engbaek J, Rietbergen H, Sparr HJ. Rapacuronium 2.0 or 2.5 mg kg-1 for rapid-sequence induction: comparison with succinylcholine 1.0 mg kg-1. Br J Anaesth. 2000 Nov;85(5):724-31. doi: 10.1093/bja/85.5.724.
- Combes X, Andriamifidy L, Dufresne E, Suen P, Sauvat S, Scherrer E, Feiss P, Marty J, Duvaldestin P. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007 Aug;99(2):276-81. doi: 10.1093/bja/aem147. Epub 2007 Jun 15.
- Domaoal AM, Weniger FC, Wolfson B. "Precurarization" using pancuronium. Anesth Analg. 1975 Jan-Feb;54(1):71-5. doi: 10.1213/00000539-197501000-00014.
- Doyle DJ. Airway anesthesia: theory and practice. Anesthesiol Clin. 2015 Jun;33(2):291-304. doi: 10.1016/j.anclin.2015.02.013.
- Kalil DM, Silvestro LS, Austin PN. Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation. AANA J. 2014 Jun;82(3):188-97.
- Martin C, Bonneru JJ, Brun JP, Albanese J, Gouin F. Vecuronium or suxamethonium for rapid sequence intubation: which is better? Br J Anaesth. 1987 Oct;59(10):1240-4. doi: 10.1093/bja/59.10.1240.
- Mostafa SM, Murthy BV, Barrett PJ, McHugh P. Comparison of the effects of topical lignocaine spray applied before or after induction of anaesthesia on the pressor response to direct laryngoscopy and intubation. Eur J Anaesthesiol. 1999 Jan;16(1):7-10. doi: 10.1046/j.1365-2346.1999.00410.x.
- Koller ME, Husby P. High-dose vecuronium may be an alternative to suxamethonium for rapid-sequence intubation. Acta Anaesthesiol Scand. 1993 Jul;37(5):465-8. doi: 10.1111/j.1399-6576.1993.tb03747.x.
- Qi DY, Wang K, Zhang H, Du BX, Xu FY, Wang L, Zou Z, Shi XY. Efficacy of intravenous lidocaine versus placebo on attenuating cardiovascular response to laryngoscopy and tracheal intubation: a systematic review of randomized controlled trials. Minerva Anestesiol. 2013 Dec;79(12):1423-35. Epub 2013 Jul 9.
- Tanaka Y, Nakayama T, Nishimori M, Sato Y, Furuya H. Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD004081. doi: 10.1002/14651858.CD004081.pub2.
- Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, Koscielniak-Nielsen Z, Skovgaard LT, Ostergaard D. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996 Jan;40(1):59-74. doi: 10.1111/j.1399-6576.1996.tb04389.x.
Study record dates
Study Major Dates
Study Start (Actual)
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
- Nervous System Diseases
- Infections
- Respiratory Tract Infections
- Respiratory Tract Diseases
- Neurologic Manifestations
- Pharyngeal Diseases
- Stomatognathic Diseases
- Otorhinolaryngologic Diseases
- Neuromuscular Manifestations
- Pharyngitis
- Muscle Hypotonia
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Membrane Transport Modulators
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Neuromuscular Agents
- Neuromuscular Nondepolarizing Agents
- Neuromuscular Blocking Agents
- Lidocaine
- Rocuronium
Other Study ID Numbers
- AB3383
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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.
Clinical Trials on Intubation Complication
-
Emory UniversityTerminatedAirway Morbidity | Intubation Complication | Anesthesia Intubation Complication | Tracheal Intubation Morbidity | Failed or Difficult Intubation, SequelaUnited States
-
University Hospital HeidelbergRecruitingIntubation | Intubation ComplicationGermany
-
Kaohsiung Medical University Chung-Ho Memorial...CompletedIntubation Complication | Intubation, DifficultTaiwan
-
Huazhong University of Science and TechnologyCompletedIntubation Complication | Intubation; DifficultChina
-
University at BuffaloTerminatedIntubation Complication | Intubation;DifficultUnited States
-
Heinrich-Heine University, DuesseldorfCompleted
-
Spanish Network for Research in Infectious DiseasesCompletedIntubation | Intubation Complication | Intubation; Difficult or FailedSpain
-
Udayana UniversityCompletedAnesthesia | Intubation Complication | Intubation;DifficultIndonesia
-
Hospital General Universitario de ValenciaFIPSERecruitingDifficult Intubation | Anesthesia Intubation ComplicationSpain
-
University Hospital, Clermont-FerrandSociété Française d'Anesthésie-Réanimation (SFAR)Not yet recruitingEndotracheal Intubation | Intubation Complication | Intubation; Difficult or Failed
Clinical Trials on Lidocaine spray (2%)
-
Khon Kaen UniversityNot yet recruitingIntubation | Hemodynamics | Laryngoscopy | Neurosurgery | LidocaineThailand
-
Lithuanian University of Health SciencesKlaipėda University; Vita Longa ClinicCompletedMouth Diseases | Throat Pain | Spraying Behavior | Throat DiseasesLithuania
-
Sawanpracharak hospitalEnrolling by invitationPain | Satisfaction, PatientThailand
-
Schwabe Pharma ItaliaCompletedPharyngitis | Sore-throatItaly
-
Beijing Ditan HospitalCompleted
-
CSA Medical, Inc.WithdrawnRadiation Proctitis | Radiation Induced Proctitis
-
Medical College of WisconsinCompleted
-
University of Wisconsin, MadisonCompleted
-
Mahidol UniversityUnknownAnesthesia of Mucous MembraneThailand
-
The University of Hong KongCompletedOral Hygiene | Frail Elderly | Nursing Homes | Chlorhexidine