- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03461718
Ketamine for Endoscopic Sedation in Outpatient Adult Endoscopy.
July 7, 2020 updated by: Jerome Edelson, Brooke Army Medical Center
Ketamine as a Sedation Adjunct for Endoscopic Procedures
We will be investigating the use of ketamine in sedation for endoscopic procedures, specifically outpatient endoscopy including esophagoduodenoscopy (EGD) and colonoscopy.
Participants will be randomized to one of two arms including conventional moderate sedation with midazolam and fentanyl or the ketamine arm.
They will then undergo the planned procedure.
Physicians preforming the procedure will be surveyed following the procedure and patients will be surveyed twice, once after meeting criteria for discharge on day of the procedure and a second time 48 hours following the procedure.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
In this study, the investigators plan to conduct a single blinded randomized controlled trial in the Gastroenterology Service to demonstrate the efficacy of ketamine and its utility in moderate sedation.
Patients presenting to the endoscopy lab for esophagogastroduodenoscopy (EGD) and/or colonoscopy who meet inclusion criteria will be approached, and if amenable, will be consented and enrolled.
Patients will be randomized to receive either a ketamine loading dose and then subsequent doses IV ketamine and midazolam 1mg IV prior to administration of ketamine or standard fentanyl/midazolam moderate sedation during their procedure.
Participants will then undergo the planned procedure.
The primary outcome will be patient satisfaction, which will be measured using the validated "Patient Satisfaction with Sedation" instrument (PSSI).
A number of secondary outcomes will include the following: (1) provider satisfaction (measured using and the "Clinician Satisfaction with Sedation" instrument (CSSI), (2) the time from sedation administration to procedure start (when the scope is inserted), (3) the time from sedation to recovery (defined as the time from the end of the procedure until the patient meets discharge criteria from the recovery area), (4) time to cecum (for colonoscopy) total doses of medications given (midazolam, fentanyl, and ketamine), (5) overall time of the procedure, (6) adverse events, (7) changes in vital signs, (8) and the need for additional medications, in particular reversal agents.
Study Type
Interventional
Enrollment (Actual)
66
Phase
- Phase 2
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
-
-
Texas
-
Fort Sam Houston, Texas, United States, 78234
- Brooke Army Medical Center
-
-
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
18 years to 65 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patients age 18 to 65 years who present to the GI clinic for an EGD or colonoscopy
Exclusion Criteria:
- Poor vital sign stability
- Hypoxia: O2 < 92%,
- Hypotension, hypertension, heart rate and respiratory rates greater than 20% above or below normal as dictated by normal ranges in SAMMC protocol
- Any allergy to ketamine, fentanyl, or midazolam
- Patient is pregnant or refuses pregnancy test, in women of child-bearing potential.*
- American Society of Anesthesiologists (ASA) score>3
- Presence of a history of psychosis, hallucinations, and/or a psychotic disorder
- History of increased intracranial pressure/ hypertensive hydrocephalus within the last 3 months
- Active pulmonary infection or disease.
History of airway instability, tracheal surgery, or tracheal stenosis.
- * Not applicable if patient is a female over 50 years old or has had a hysterectomy and/or oophorectomy
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: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Ketamine
Group will receive ketamine 0.5-1mg/kg for a loading dose then subsequent IV pushes of 10-20mg for maintenance.
1mg IV of midazolam will be administered prior to ketamine for anxiolysis and to help minimize emergence reaction.
|
Experimental arm for sedation.
Part of standard sedation regimen and anxiolysis and for minimization of emergence reaction
|
ACTIVE_COMPARATOR: Control
This group will receive midazolam and fentanyl alternated as currently preformed for endoscopy.
|
Part of standard sedation regimen and anxiolysis and for minimization of emergence reaction
Part of standard sedation regimen
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Provider satisfaction
Time Frame: Measured within 15 minutes post proceudre
|
Measured with CSSI score.
This consists of a questionnaire administered to the provider following the procedure with questions detailing different aspects of the procedure.
Answers will be summed and the scores are normalized to a scale of 0-100 (high scores denote higher satisfaction).
|
Measured within 15 minutes post proceudre
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sedation time
Time Frame: During the procedure
|
Time from sedation administration until procedure start, will be measured in minutes
|
During the procedure
|
Time to cecum (for colonoscopy)
Time Frame: During the procedure
|
Time required for endoscopist to reach the cecum, will be measured in minutes
|
During the procedure
|
Total dose of medications given
Time Frame: During the procedure
|
All doses of medications will be summed and reported.
|
During the procedure
|
Overall procedure time
Time Frame: During the procedure
|
The time from procedure start to procedure completion will be measured in minutes
|
During the procedure
|
Adverse events
Time Frame: During the procedure
|
Are detailed in the protocol.
We will be recording the presence or absence of adverse events.
|
During the procedure
|
Changes in vital signs
Time Frame: During the procedure
|
As defined in the protocol.
We will be recording all vital signs for later analysis.
|
During the procedure
|
Need for additional medications, ie reversal agents
Time Frame: During the procedure
|
Will be measured as yes or no, specific dose and medication will be recorded for analysis.
|
During the procedure
|
Patient Satisfaction
Time Frame: After patient reaches criteria for discharge as listed above, a survey will be preformed. It will also be preformed 48 hours post procedure with the patients being called. Two surveys will end patient participation in the study.
|
Measured with PSSI score.
This consists of a questionnaire administered to the provider following the procedure with questions detailing different aspects of the procedure.
Answers will be summed and the scores are normalized to a scale of 0-100 (high scores denote higher satisfaction).
Criteria for discharge are at least 30 minutes elapsed since the last dose of sedative medication was administered, presence of protective reflexes (swallow and gag), stable vital signs, patient passes trial of ambulation (if was ambulating prior to procedure, a responsible adult is present to drive patient home and remain with the patient the length of two half-lives of the medications administered for sedation, and there are no staff concerns about safety.
After the patient meets discharge criteria, a survey will be preformed.
It will also be repeated once at the 48 hour post-procedure time.
Conclusion of the two surveys concludes patient participation in the study.
|
After patient reaches criteria for discharge as listed above, a survey will be preformed. It will also be preformed 48 hours post procedure with the patients being called. Two surveys will end patient participation in the study.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Jerome C Edelson, MD, BAMC
- Study Chair: John G Gancayco, MD, BAMC
- Study Director: Cyrus V Edelson, MD, BAMC
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
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)
March 5, 2018
Primary Completion (ACTUAL)
October 1, 2019
Study Completion (ACTUAL)
October 1, 2019
Study Registration Dates
First Submitted
February 23, 2018
First Submitted That Met QC Criteria
March 9, 2018
First Posted (ACTUAL)
March 12, 2018
Study Record Updates
Last Update Posted (ACTUAL)
July 8, 2020
Last Update Submitted That Met QC Criteria
July 7, 2020
Last Verified
July 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
- 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
- Analgesics, Opioid
- Narcotics
- Tranquilizing Agents
- Psychotropic Drugs
- Hypnotics and Sedatives
- Adjuvants, Anesthesia
- Anti-Anxiety Agents
- GABA Modulators
- GABA Agents
- Ketamine
- Fentanyl
- Midazolam
Other Study ID Numbers
- C.2017.175
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
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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