- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03040024
Delirium Prevention With Ketamine in Ear, Nose, and Throat (ENT) Patients
A Randomized Placebo-controlled Pilot Study of Single-dose Intraoperative Ketamine for the Prevention of Delirium in Otolaryngeal Cancer Surgery Patients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a single center prospective randomized double blinded placebo controlled study.
The primary aim of the study is to optimize the intraoperative treatment protocol for head and neck cancer patients to reduce the incidence of delirium and associated postoperative cognitive dysfunction. Secondary aims are to determine the dose response relationship for intraoperative ketamine and delirium reduction, determine if a single dose of ketamine will reduce post-operative pain and opioid requirements, determine if raw electroencephalogram (EEG) data can predict postoperative delirium during general anesthesia, and to evaluate length of intensive care unit (ICU) and length of hospital stay.
Participants will be randomized to one of three groups after administration of general anesthesia; one dose of .5 mg/kg intravenous (IV) Ketamine, 1.0 mg/kg of IV Ketamine, or IV placebo.
An EEG will be used during the surgical procedure to gather raw data for off line analysis among patients developing post-operative delirium.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Georgia
-
Atlanta, Georgia, United States, 30308
- Emory University Hospital Midtown
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Current diagnosis of otolaryngeal cancer and undergoing surgery with general anesthesia
- Competent to provide informed consent
Exclusion Criteria:
- Emergency surgery
- Monitored Anesthesia Care (i.e., regional anesthesia alone without plans for general anesthesia)
- Surgery involving the eye, eyebrow, forehead, or frontal scalp near the sensor placement
- Poor health literacy
- Allergy, or have experienced any drug reaction to ketamine
- Pregnant or lactating
- Currently in active alcohol withdrawal
- Taking buprenorphine for chronic pain
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ketamine 0.5 mg/kg
Participants undergoing surgery for otolaryngeal cancer will be randomized to receive one dose of IV ketamine at 0.5 mg/kg.
|
Ketamine will be administered intravenously after administration of general anesthesia and prior to the first surgical incision.
A processed EEG device will be used during the surgical procedure to gather raw EEG data for off line analysis among patients developing post-operative delirium.
|
Experimental: Ketamine 1.0 mg/kg
Participants undergoing surgery for otolaryngeal cancer will be randomized to receive one dose of IV ketamine at 1.0 mg/kg.
|
Ketamine will be administered intravenously after administration of general anesthesia and prior to the first surgical incision.
A processed EEG device will be used during the surgical procedure to gather raw EEG data for off line analysis among patients developing post-operative delirium.
|
Placebo Comparator: Placebo
Participants undergoing surgery for otolaryngeal cancer will be randomized to receive one dose of IV saline/placebo.
|
A processed EEG device will be used during the surgical procedure to gather raw EEG data for off line analysis among patients developing post-operative delirium.
Placebo will be administered intravenously after administration of general anesthesia and prior to the first surgical incision.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Confusion Assessment Method fo Intensive Care Unit (CAM-ICU) Delirium Score
Time Frame: Baseline (Up to 30 minutes after PACU arrival), Post Operative (PACU discharge up to 6 hours)
|
The CAM-ICU assesses four features: 1) acute change or fluctuation in mental status from baseline, 2) inattention, 3) altered level of consciousness, and 4) disorganized thinking.
The measure reports whether a participant meets criteria for delirium by summing the number of features answered as "present".
Feature 1 plus 2 and either 3 or 4 present = delirium positive.
Results are expressed as number of participants with or without delirium at each time frame.
|
Baseline (Up to 30 minutes after PACU arrival), Post Operative (PACU discharge up to 6 hours)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Behavioral Pain Scale (Non-Intubated) Score
Time Frame: Post Operation (Up to 6 Hours), Post Operation Day 0
|
The Behavioral Pain Scale.
Scores range from 3 (no pain) to 12 (maximum pain).
|
Post Operation (Up to 6 Hours), Post Operation Day 0
|
Change in Pain Level Assessed by the Visual Analog Scale (VAS) Score
Time Frame: Baseline, Post Surgery (PACU), Post surgery (POD 0), Post surgery (POD 1), Post surgery (POD 2), Post surgery (POD 3), Post surgery (follow up visit - Up to 6 weeks)
|
Scores range from 0 (no pain) to 10 (worst pain).
|
Baseline, Post Surgery (PACU), Post surgery (POD 0), Post surgery (POD 1), Post surgery (POD 2), Post surgery (POD 3), Post surgery (follow up visit - Up to 6 weeks)
|
Change in Mini Cog Score
Time Frame: Baseline, Post Surgery (Up to 6 Weeks)
|
The Mini-Cog is a 3-minute instrument that can increase detection of cognitive impairment.
A score ranging from 0-2 indicates positive screen for dementia.
A score ranging from 3-5 indicates negative screen for dementia.
|
Baseline, Post Surgery (Up to 6 Weeks)
|
Change in Mini-Mental Status Examination (MMSE) Score
Time Frame: Baseline, Post Surgery (Up to 6 Weeks)
|
The MMSE is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment.
Any score greater than or equal to 24 points (out of 30) indicates a normal cognition.
Below this (0-24), scores can indicate cognitive impairment.
|
Baseline, Post Surgery (Up to 6 Weeks)
|
Change in Cognitive Failure Questionnaire (CFQ) Score
Time Frame: Baseline, Post Surgery (Up to 6 Weeks)
|
The CFQ is a 25-item self-report measure of failures in attention, perception, memory, and action.
Participants are asked to indicate on a 5-point scale how often they have experienced each failure in the past months, from 0 (never) to 5 (very often).
Scores range from 0 to 100 a higher score indicating more failures in attention.
|
Baseline, Post Surgery (Up to 6 Weeks)
|
Post Operative Narcotics Use
Time Frame: Post Intervention (Intraoperative), Post Intervention (POD 0), Post Intervention (POD 1),Post Intervention (POD 2),Post Intervention (POD 3), Post Intervention (Follow up visit-up to 6 weeks post intervention)
|
The total amount of narcotics used measured in morphine milligram equivalents (MME).
|
Post Intervention (Intraoperative), Post Intervention (POD 0), Post Intervention (POD 1),Post Intervention (POD 2),Post Intervention (POD 3), Post Intervention (Follow up visit-up to 6 weeks post intervention)
|
Associations of Intraoperative EEG Patterns With PACU Delirium
Time Frame: Intraoperative EEG and delirium during PACU stay
|
The investigators compared the relative beta power derived from the normalized power spectral density (PSD) in patients with and without PACU delirium (positive and negative delirium).
Only a total of 38 EEGs with sufficient quality were analyzed.
Results are expressed in percentage of cumulative power.
A higher beta power correlates with worse outcome.
Averages and standard deviations are shown.
|
Intraoperative EEG and delirium during PACU stay
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Vanessa Moll, PhD, Emory University
Study record dates
Study Major Dates
Study Start (Actual)
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
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Nervous System Diseases
- Neurologic Manifestations
- Confusion
- Neurobehavioral Manifestations
- Neurocognitive Disorders
- Delirium
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Dissociative
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Excitatory Amino Acid Antagonists
- Excitatory Amino Acid Agents
- Ketamine
Other Study ID Numbers
- IRB00086609
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
product manufactured in and exported from the U.S.
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 Otolaryngeal Cancer
-
University of Michigan Rogel Cancer CenterRecruitingCancer Liver | Cancer Brain | Cancer Head &Neck | Cancer PelvisUnited States
-
Cellworks Group Inc.RecruitingCancer | Relapsed Cancer | Refractory CancerUnited States
-
UNC Lineberger Comprehensive Cancer CenterHyundai Hope On WheelsRecruitingCancer | Pediatric Cancer | Survivorship | Cancer MetastaticUnited States
-
Vanderbilt-Ingram Cancer CenterNational Institutes of Health (NIH)Active, not recruitingAdvanced Cancer | Relapsed Cancer | Refractory CancerUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)CompletedStage III Pancreatic Cancer | Stage IIA Pancreatic Cancer | Stage IIB Pancreatic Cancer | Stage IV Gastric Cancer | Stage IVA Colorectal Cancer | Stage IVA Pancreatic Cancer | Stage IVB Colorectal Cancer | Stage IVB Pancreatic Cancer | Stage IIIA Gastric Cancer | Stage IIIB Gastric Cancer | Stage IIIC Gastric... and other conditionsUnited States
-
MiRXES Pte LtdRecruitingBreast Cancer | Gastric Cancer | Colorectal Cancer | Pancreatic Cancer | Esophageal Cancer | Ovarian Cancer | Prostate Cancer | Thoracic Cancer | Liver CancerSingapore
-
Sidney Kimmel Cancer Center at Thomas Jefferson...CompletedStage I Breast Cancer | Stage I Uterine Corpus Cancer | Stage II Uterine Corpus Cancer | Stage III Uterine Corpus Cancer | Stage II Breast Cancer | Stage IIIA Breast Cancer | Stage IIIB Breast Cancer | Stage IA Breast Cancer | Stage IB Breast Cancer | Stage IIA Breast Cancer | Stage IIB Breast Cancer | Stage... and other conditionsUnited States
-
Massachusetts General HospitalNational Comprehensive Cancer NetworkCompletedGastric Cancer | Pancreatic Cancer | Esophageal Cancer | Rectal Cancer | Colon Cancer | Hepatobiliary CancerUnited States
-
Johns Hopkins UniversityNational Cancer Institute (NCI); National Institute on Minority Health and...Enrolling by invitationCancer | Advanced Cancer | End Stage Cancer | MalignancyUnited States
-
University of California, San FranciscoBristol-Myers Squibb; PfizerTerminatedStage IIIA Rectal Cancer | Stage IIIB Rectal Cancer | Stage IIIC Rectal Cancer | Metastatic Colorectal Adenocarcinoma | Metastatic Colon Adenocarcinoma | Metastatic Rectal Adenocarcinoma | Stage IIIA Colon Cancer | Stage IIIB Colon Cancer | Stage IIIC Colon Cancer | Stage IV Colon Cancer | Stage IV Rectal... and other conditionsUnited States
Clinical Trials on Ketamine
-
Grace Lim, MD, MSNational Institute of Mental Health (NIMH)RecruitingPain, Postoperative | Depression, PostpartumUnited States
-
Ullevaal University HospitalUniversity of OsloCompleted
-
Assistance Publique - Hôpitaux de ParisCompletedArthroplasty, Replacement, HipFrance
-
Assiut UniversityCompletedKetamine Causing Adverse Effects in Therapeutic UseEgypt
-
The University of Texas Health Science Center,...TerminatedPost Partum DepressionUnited States
-
Lotus Clinical Research, LLCiX Biopharma Ltd.Completed
-
Lawson Health Research InstituteUnknownBone Fractures | Dislocations
-
Eye & ENT Hospital of Fudan UniversityCompletedPain, Procedural | Emotions | Separation AnxietyChina
-
Antonios LikourezosCompleted