- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03411239
Airway Pressure Changes Using Esophageal Balloon Catheter (OBC) in Laparoscopic Surgery
Assessment of Airway Pressure Changes Using Esophageal Balloon Catheter (OBC) in Patients Undergoing Laparoscopic Surgery Under General Anaesthesia
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
General anaesthesia: Patients will be induced and intubated as per the choice of consultant anaesthetist. Anaesthesia will be maintained with inhalational agent and paralysis maintained with atracurium infusion or bolus so as to keep train of four counts <2 twitches using peripheral nerve stimulator throughout surgery. Conventional ventilation was standardised with mode as pressure control ventilation, pressure inspired targeted to either tidal ventilation of 6-8 ml/kg or end tidal carbon di oxide concentration of 40-50 mmHg and positive end expiratory pressure limited to 5 cm of water. Fraction of inspiratory oxygen was adjusted to keep oxygen saturation > 95%. No recruitment manoeuvres were permitted unless, patient is desaturating actively, and in which case patient will be excluded from the study. Abdominal cavity was insufflated with carbon dioxide with initial high flow and pressure, but later the pressure was maintained at 15cm water.
Esophageal balloon catheter insertion, placement and removal: After applying topical anaesthetic (10% lidocaine spray) to patient's nasopharynx and water-soluble lubricant jelly to distal end of esophageal catheter, it is inserted into patient's esophagus via nasal cavity or oropharyngeal cavity. Estimated depth of catheter insertion is calculated as: patient's height (in cm) X 0.288. Once the esophageal balloon catheter is inserted to estimated depth, balloon is inflated with 4 ml of air and pressure on the stomach is applied to look for positive deflection of oesophageal pressure reading. Once convinced, 2 ml air was taken out and catheter was slowly withdrawn till cardiac oscillations are visible. Occlusion test is performed to confirm the placement of catheter in lower thoracic region. In occlusion test, patient is briefly disconnected from ventilator, endotracheal tube is blocked and pressure is applied on to chest wall. Simultaneous increase in oesophageal balloon pressure and airway pressure is noted. (Change is oesophageal pressure/ change in airway pressure on application of external pressure should be close to 1). Stylet is removed and Oesophageal balloon catheter is secured at this position on nostril or angle of mouth similar to nasogastric tube and connected to pressure transducer to do necessary measurements. Catheter is removed at the end of surgery before extubation after complete deflation of cuff.
Measurements: Soon after confirmation of position, patient is subjected to end inspiratory hold to record the end inspiratory pleural pressure and plateau airway pressure. Patient is then subjected to end expiratory hold to record end expiratory pleural pressure and positive end expiratory pressure. Similar steps are repeated once pneumoperitoneum is achieved and patient is placed in trendelenburg or reverse trendelenburg position and once pneumoperitoneum deflated. Problems encountered during insertion and measurement of esophageal balloon catheter will be resolved using manufacturer's recommendation.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: ROHIT V AGRAWAL, MMed, FANZCA
- Phone Number: 67744208
- Email: rohit_agrawal@nuhs.edu.sg
Study Locations
-
-
-
Singapore, Singapore, 119074
- National University Health System
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- ASA grade 1 and 2 patients,
- Age > 21 yrs.
- Elective intraabdominal laparoscopic surgery
Exclusion Criteria:
- ASA grade 3 and 4 patients
- Emergency surgery
- Patient with tracheostomy
- Patient with any oropharyngeal pathology
- Patients with co-existing respiratory disease i.e. COPD, restrictive lung disease.
- Patients with oesophageal diseases: varicose, stricture, recent esophageal or gastric surgery.
- Patients with nasopharyngeal diseases: sinusitis, epistaxis, nasopharyngeal carcinoma post radiotherapy or chemotherapy.
- Age < 21 years
- Pregnant females
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: Interventional arm
Patients recruited will have OBC inserted under general anaesthesia and various pressure measured
|
Using OBC to determine airway pressure changes in patients undergoing general anaesthesia for laparoscopic surgery
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Inspiratory and expiratory oesophageal pressure during laparoscopic surgery
Time Frame: 1 year
|
using pressure monitoring line
|
1 year
|
Inspiratory and expiratory transpulmonary pressure during laparoscopic surgery
Time Frame: 1 year
|
difference between oesophageal pressure and airway pressures
|
1 year
|
Inspiratory and expiratory transpulmonary pressure during supine, trendelenburg and reverse trendelenburg position
Time Frame: 1 year
|
difference between esophageal pressure and airway pressure in various positions
|
1 year
|
Collaborators and Investigators
Investigators
- Principal Investigator: Rohit V Agrawal, MMed, FANZCA, Consultant, Department of Anaesthesia, NUH
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 (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 2017/00153
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
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.
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