- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03085563
A Comparison of Intranasal Midazolam and Nitrous Oxide (N2O) Minimal Sedation for Minor Procedures in a Pediatric Emergency Department
April 14, 2022 updated by: University of Colorado, Denver
The objective of this project is to compare the sedative effects of intranasal midazolam versus inhaled nitrous oxide (N2O) for minor procedures in the pediatric emergency department.
The primary outcome will be length of stay (LOS) in the emergency department (ED) stay for minor procedures.
Secondarily the investigators will compare patient/family and provider satisfaction while using either intranasal midazolam or N2O for minimal sedation.
The investigators hypothesize that the total length of stay for children undergoing minor procedures in the ED will be lower for N2O, as compared to intranasal midazolam.
The investigators also hypothesize that patient/family and provider satisfaction will be higher with N2O and adverse effects will not differ between N2O and intranasal midazolam.
Patients will receive either intranasal midazolam or N2O for minor procedures.
Following the enrollment period, data will be analyzed and the two will be compared.
Total length of stay, patient/family and provider satisfaction will be studied.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
63
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Colorado
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Aurora, Colorado, United States, 80045
- Children's Hospital Colorado
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
2 years to 17 years (Child)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patients ≥2 years of age and <18 years of age, and
- Parent/legal guardian age ≥18 years of age to <80 years of age
- Patients with an American Society of Anesthesiologists (ASA) Physical Status Classification System level 1, 2, and 3
Patients requiring anxiolysis and mild sedation for minor procedures
- Minor procedures will include simple lacerations less than 4 cm
- Lumbar punctures
- Minor incision
- Drainage of abscesses that do not require extensive debridement
Must receive the standard of care dosing for either nitrous oxide or intranasal midazolam.
- Nitrous oxide up to 70% nitrous concentration will be allowed
- Intranasal Midazolam 0.4mg/kg with a max dose of 10mg
Exclusion Criteria:
- Nasal injury, nasal obstruction or significant congestion
- Laceration that involves the nose and ears or come into contact with the scavenger device or nitrous oxide tubing
- Allergy to benzodiazepines
- Benzodiazepine dosing for any reason 24 hours prior to procedure
- Excessive Epistaxis
- Facial or nasal deformity
- Copious mucous
- Recent (less than 1 week) tympanic membrane graft or middle ear surgery
- Recent bleomycin therapy
- Patients known to be pregnant at time of enrollment
- Patients with severe behavior problems, personality disorders or other mind-altering conditions as determined by administering provider.
Closed space situations such as:
- pneumothorax,
- air embolus,
- pneumocephalus, or
- craniotomy in the last 3 weeks,
- intraocular surgery with retained gas,
- pulmonary bullae,
- severe emphysema, or
- bowel obstruction.
Patients with significant co-morbidities:
- severe pulmonary disease,
- cardiac disease,
- hematologic diseases associated with B12 deficiency,
- sickle cell disease.
- Patients with acute otitis media and/or sinusitis
- History of paradoxical reaction to nitrous oxide
- Known Methicillin-resistant Staphylococcus aureus (MRSA+) patients
- Co-administration of additional sedation or analgesic medications
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Nitrous Oxide
Nitrous oxide will be delivered in one of two ways, using the titration method or rapid infusion method.
|
Nitrous oxide will be delivered in one of two ways, using the titration method or rapid infusion method.
Which ever method is used will be recorded.
When using the titration method, starting at 20%, nitrous oxide will be added in 10% increments every 60 seconds until the ideal level of sedation has been met (not to exceed 70% nitrous oxide).
Using the rapid infusion method, after the proper flow rate has been achieved with oxygen, the flowmeter will be increased to obtain 50% concentration of nitrous oxide.
After 2-3 minutes if the patient does not have adequate sedation, nitrous oxide concentration will be increased to 70%.
Other Names:
|
Active Comparator: Intranasal Midazolam
Intranasal midazolam with mucosal atomizer device administration will follow the Children's Hospital Colorado (CHCO) established policy 'Intranasal Administration (atomization) of Medications'.
|
Intranasal midazolam with mucosal atomizer device administration will follow the Children's Hospital Colorado (CHCO) established policy 'Intranasal Administration (atomization) of Medications'.
As per standard of care, each patient will receive a standardized dose of 0.4mg/kg (maximum dose of 10mg) of intranasal midazolam with the mucosal atomizer device for all procedures.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ED Length of Stay After Intranasal Midazolam or Nitrous Oxide Administration
Time Frame: From administration of intranasal midazolam or nitrous oxide, assessed over an estimated time of 2 hours.
|
The total length of Emergency Department (ED) stay will be defined as time from intranasal midazolam or nitrous oxide administration to time of discharge readiness, collected by the research assistants.
Additional time periods measured will include: time from anxiolytic/sedative given to time of procedure completion, and total time for recovery.
|
From administration of intranasal midazolam or nitrous oxide, assessed over an estimated time of 2 hours.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient/Parent and Provider Satisfaction With Sedation and Anxiolytic/Sedative.
Time Frame: Time of discharge, Approximately 2 hours
|
Patient/parent satisfaction will be assessed for all patients; child satisfaction will be assessed for patients over 12 years of age.
Satisfaction will be measured on a scale of 1 to 5 (1 being not satisfied and 5 being very satisfied).
Specifically, parents (and children when applicable) will be asked "how satisfied with the means of sedation were you for the procedure performed".
Research assistants will then ask the ED providers on a scale of 1 to 5 (1 being not satisfied and 5 being very satisfied) "how satisfied with the means of sedation were you for the procedure performed".
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Time of discharge, Approximately 2 hours
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Adverse Events.
Time Frame: Time of discharge, Approximately 2 hours
|
Number of adverse events observed.
Adverse events will be classified and defined as hypoxia, need for administration of reversal agent, nausea, vomiting, paradoxical reaction, airway obstruction, laryngospasm, inadequate sedation, allergic reaction, and cardiac arrest.
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Time of discharge, Approximately 2 hours
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Paul A Szefler, MD, University of Colorado, Denver
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 24, 2017
Primary Completion (Actual)
November 8, 2018
Study Completion (Actual)
November 8, 2018
Study Registration Dates
First Submitted
October 21, 2016
First Submitted That Met QC Criteria
March 14, 2017
First Posted (Actual)
March 21, 2017
Study Record Updates
Last Update Posted (Actual)
May 10, 2022
Last Update Submitted That Met QC Criteria
April 14, 2022
Last Verified
April 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Wounds and Injuries
- Disease Attributes
- Emergencies
- Lacerations
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Analgesics, Non-Narcotic
- Tranquilizing Agents
- Psychotropic Drugs
- Hypnotics and Sedatives
- Adjuvants, Anesthesia
- Anti-Anxiety Agents
- GABA Modulators
- GABA Agents
- Anesthetics, Inhalation
- Midazolam
- Nitrous Oxide
Other Study ID Numbers
- 16-1909
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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