- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04396548
Midodrine for Improving Hemodynamics After Spinal Anesthesia
January 18, 2021 updated by: Mahmoud Mohammed Alseoudy, Mansoura University
Preoperative Midodrine for Improving Hemodynamics in Orthopedic Patients Undergoing Spinal Anesthesia
Neuraxial blockade such as spinal anaesthesia can cause severe hypotension due to pharmacological sympathectomy resulting in potential deleterious consequences for the patient.
Prevention of this spinal anaesthesia induced hypotension is of utmost importance.
Techniques currently in use for preventing hypotension include intravenous fluid prehydration, sympathomimetic drugs, and physical methods such as leg bindings and compression stockings.
Midodrine is a direct acting α1-adrenoceptor agonist which causes venous and arterial vasoconstriction through stimulation of α1- receptors located in the vasculature.
The aim of this study is to evaluate the efficacy and safety of prophylactic midodrine use with preoperative fluid hydration before spinal anesthesia in the prevention of hypotension in patients undergoing elective orthopedic surgery.
We hypothesize that intraoperative hypotension would be less in patients given midodrine and intravenous fluid prehydration preoperatively before spinal anesthesia.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Neuraxial blockade such as spinal anaesthesia can cause severe hypotension due to pharmacological sympathectomy resulting in potential deleterious consequences for the patient.
Prevention of this spinal anaesthesia induced hypotension is of utmost importance.
Several techniques and methodologies have been adopted for the prevention of this neuraxial hypotension with varying degree of success.
Techniques currently in use for preventing hypotension include intravenous fluid prehydration, sympathomimetic drugs, and physical methods such as leg bindings and compression stockings.
Midodrine is a direct acting α1-adrenoceptor agonist which causes venous and arterial vasoconstriction through stimulation of α1- receptors located in the vasculature.
The net result is an increase in vascular tone and systolic blood pressure.
Cardiac β-receptors are unaffected and there is no significant blood brain barrier penetration.
We hypothesize that intraoperative hypotension would be less in patients given midodrine and intravenous fluid prehydration preoperatively before spinal anesthesia.
The study will include 80 patients who will be scheduled for elective orthopedic surgery on the lower extremities undergoing spinal anesthesia.
It will be conducted in Mansoura University Hospital after getting approval from Institutional Review Board (IRB), Faculty of medicine, Mansoura University.
Informed written consents will be obtained from all subjects in the study after ensuring confidentiality.
Patients will be randomly allocated using computer generated random numbers to either treatment with midodrine (group M) or control (group C) using the sealed opaque envelope technique.
Patients in group M will receive oral 10 mg tablet of midodrine with small sips of water one hour before arrival in the operation room while patients in group C will receive inert tablet containing sugar (placebo) at the same time.
All patients will be monitored in with noninvasive blood pressure as well ascontinuous electrocardiogram (ECG) and pulse oximetry (SpO2).
Before placement of spinal anesthesia, all patients will receive an IV bolus of 10mL/kg of Lactated Ringer's.
Spinal anesthesia (midline puncture) will be performed in sitting position by a staff anesthetist at L3-L4 or L4-L5 with a 25-gauge Withacre needle injecting 12.5 mg of hyperbaric 0.5% bupivacaine (2.5 mL) with 10μg fentanyl.
After injection,the patients will be turned supine.
The baseline arterial blood pressure (mean) will be calculated as the average of 3 consecutive measurements before placement of the SA every 15 min after taking midodrine and every 5 min for 30 min after spinal anesthesia.
Any vasovagal syncopes will be recorded.
After placement of the SA, the patient's heart rate will be obtained every five minutes for 30 minutes and thereafter, in accordance with standard clinical practice, every 5 minutes until the end of surgery.
The dermatome level of the sensory block using loss of pinprick will be checked every 5 minutes for 20minutes.
The modified Bromage scale (0 = no motor block, 1 = straight leg hip flexion blocked, 2 = knee flexion blocked, 3 = complete motor block) will be used to quantify the degree of motor block at 20 minutes.
Reqirements of ephedrine and atropine and fluide intake will be recorded.
time to onset of the first hypotension, the proportion of patients without hypotension, and the number of bradycardic episodes per patient will also be recorded.
Perioperative copmlications such as reactive hypertension, nausea, vomiting, hypothermia, shivering and postdural puncture headache will be recorded.
An investigator who is blind to type of intervention wil be responsible for collection of data.
Study Type
Interventional
Enrollment (Actual)
70
Phase
- Not Applicable
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
-
-
-
Mansoura, Egypt
- Mansoura University Hospital
-
-
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
16 years to 63 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
• American Society of Anesthesiologists (ASA) status: 1 or 2 .
- Orthopedic surgery on the lower extremities
Exclusion Criteria:
• Pheochromocytoma. .Throtoxicosis. .Structural heart disease.
- Baseline blood pressure more than 140/90 .Acute kidney failure.
- Any contraindications to spinal anesthesia such as local infection and coagulopathy
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 Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Group A (midodrine group)
Midodrine will be given orally with small sips of water one hour before arrival in the operation room before spinal anesthesia
|
Patients will receive oral 10 mg tablet of midodrine with small sips of water one hour before arrival in the operation room.
All patients will be monitored in with noninvasive blood pressure as well as continuous electrocardiogram (ECG) and pulse oximetry (SpO2).
Before placement of spinal anesthesia, all patients will receive an IV bolus of 10mL/kg of Lactated Ringer's .
Spinal anesthesia (midline puncture) will be performed in sitting position by a staff anesthetist at L3-L4 or L4-L5 with a 25-gauge Withacre needle injecting 12.5 mg of hyperbaric 0.5% bupivacaine (2.5 mL) with 10μg fentanyl.
After injection,the patients will be turned supine.
Other Names:
|
Placebo Comparator: Group B (placebo group):
Inert tablet containing sugar (placebo) will be given orally with small sips of water one hour before arrival in the operation room before spinal anesthesia
|
: Patients will receive Inert tablet containing sugar (placebo) with small sips of water one hour before arrival in the operation room.
All patients will be monitored in with noninvasive blood pressure as well as continuous electrocardiogram (ECG) and pulse oximetry (SpO2).
Before placement of spinal anesthesia, all patients will receive an IV bolus of 10mL/kg of Lactated Ringer's .
Spinal anesthesia (midline puncture) will be performed in sitting position by a staff anesthetist at L3-L4 or L4-L5 with a 25-gauge Withacre needle injecting 12.5 mg of hyperbaric 0.5% bupivacaine (2.5 mL) with 10μg fentanyl.
After injection,the patients will be turned supine
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
1. incidence perioperative hypotension
Time Frame: Up to 4 hours after surgery
|
the number of hypotensive patients will be recorded
|
Up to 4 hours after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
change in mean arterial blood pressure
Time Frame: Up to 4 hours after surgery
|
Mean arterial blood pressure will be recorded basal and every 15 min after taking midodrine and every 5 min after spinal anesthesia till end of surgery and every
|
Up to 4 hours after surgery
|
change in heart rate
Time Frame: Up to 4 hours after surgery
|
heart rate will be recorded basal and every 15 min after taking midodrine and every 5 min after spinal anesthesia till end of surgery and every 15 minutes after surgery
|
Up to 4 hours after surgery
|
requirements of ephedrine and atropine
Time Frame: Up to 4 hours after the procedure
|
amount of ephedrine and atropine to treat hypotension and bradycardia
|
Up to 4 hours after the procedure
|
incidence of adverse effects
Time Frame: Up to 24 hours surgery
|
nausea, vomiting, shivering and postdural puncture headache will be recorded
|
Up to 24 hours surgery
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Mahmoud M Alseoudy, MD, Faculty of Medicine, Mansoura University
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)
June 8, 2020
Primary Completion (Actual)
December 29, 2020
Study Completion (Actual)
December 29, 2020
Study Registration Dates
First Submitted
May 16, 2020
First Submitted That Met QC Criteria
May 16, 2020
First Posted (Actual)
May 20, 2020
Study Record Updates
Last Update Posted (Actual)
January 22, 2021
Last Update Submitted That Met QC Criteria
January 18, 2021
Last Verified
January 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Hypotension
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Autonomic Agents
- Peripheral Nervous System Agents
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Sympathomimetics
- Vasoconstrictor Agents
- Adrenergic alpha-1 Receptor Agonists
- Anesthetics
- Midodrine
Other Study ID Numbers
- Midodrine and SA
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
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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