- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04485273
Effect of Dexmedetomedine in Subtenon's Block on Emergence Agitation in Pediatric Strabismus Surgery
Effect of Dexmedetomedine in Subtenon's Block on Emergence Agitation in Pediatric Strabismus Surgery Under Sevoflurane Anesthesia
Study Overview
Status
Conditions
Detailed Description
Emergency agitation is a clinical status of postoperative excitement or emergence delirium when the patient is awake but is disorientated. It is described as mental disturbances that consist of confusion, hallucinations and delusions which is manifested by restless involuntary physical activity and thrashing about the bed. Its incidence has been observed especially in pediatric ophthalmology care units due to many factors such as pain, mental status, time of operation, age, lack of ability to see outside, and a history of previous hyperthermia. Strabismus surgery is one of the most frequently performed pediatric ocular operations. However, it can cause unfavorable side effects during intraoperative and postoperative periods. Typically, the major problems associated with strabismus surgeries include increased risk of the oculocardiac reflex, postoperative pain, nausea and vomiting. Subtenon's block is one of the regional anesthetic techniques used in ocular surgery. Dexmedetomidine has been used as an adjuvant to local anesthetics for regional anesthesia in various clinical fields including the subtenon's block.There is evidence that dexmedetomidine decreases the incidence of agitation after sevoflurane anesthesia in children undergoing different surgical procedures. Therefore, this study is conducted to evaluate the effect of dexmedetomedine in subtenon's block on emergence agitation in pediatric strabismus surgery under sevoflurane anesthesia.
This prospective, randomized, clinical study includes 100 children who are scheduled for elective strabismus surgery under general surgery in Mansoura ophthalmology center. Informed written consent is obtained from parents of all subjects in the study after ensuring confidentiality.The study protocol is explained to parents of all patients in the study who are kept fasting prior to surgery. Patients are randomly assigned to two equal groups according to computer-generated table of random numbers using the permuted block randomization method.The collected data are coded, processed, and analyzed using SPSS program. All data are considered statistically significant if P value is ≤ 0.05.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Dakahlia
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Mansoura, Dakahlia, Egypt, 35511
- Department of Anesthesia, Mansoura University Hospitals
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- American Society of Anesthesiology (ASA) I and II patients.
- Scheduled for strabismus surgery.
Exclusion Criteria:
- Parental refusal of consent.
- Contraindication to use of supraglottic airway device as gastroesophageal reflux and oropharyngeal pathology.
- Hyperactive airway disease or respiratory diseases.
- Children with developmental delays, mental or neurological disorders.
- Bleeding or coagulation diathesis.
- History of known sensitivity to the used anesthetics.
- Previous surgery in the same eye
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Dexmedetomedine Group
Laryngeal mask airway is inserted and anesthesia is maintained with sevoflurane.
Subtenon's block is performed and local anesthetic solution is injected, in addition to dexmedetomedine.
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Capnography connected to laryngeal mask airway is introduced after adequate jaw relaxation and oral airway tolerance; its size is chosen according to the body weight of the child.
Other Names:
Sevoflurane in air/oxygen mixture of 40% is titrated to achieve adequate depth of anesthesia.
Other Names:
Subtenon's block is performed in the eye undergoing surgery under sterile conditions where a 19-gauge curved blunt metallic cannula (25 mm) is inserted into sub-tenon's space.
Other Names:
The local anesthetic solution is injected with a dose of 0.5% bupivacaine (0.08 ml/kg), in addition to dexmedetomedine (0.5 μg /kg)
Other Names:
|
PLACEBO_COMPARATOR: Control Group
Laryngeal mask airway is inserted and anesthesia is maintained with sevoflurane.
Subtenon's block is performed and local anesthetic solution is injected.
|
Capnography connected to laryngeal mask airway is introduced after adequate jaw relaxation and oral airway tolerance; its size is chosen according to the body weight of the child.
Other Names:
Sevoflurane in air/oxygen mixture of 40% is titrated to achieve adequate depth of anesthesia.
Other Names:
Subtenon's block is performed in the eye undergoing surgery under sterile conditions where a 19-gauge curved blunt metallic cannula (25 mm) is inserted into sub-tenon's space.
Other Names:
The local anesthetic solution is injected with a dose of 0.5% bupivacaine (0.08 ml/kg).
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in postoperative emergence agitation scale
Time Frame: Up to 30 minutes after surgery
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Agitation is assessed using the 5- step Cravero scale (1-5) every five minutes from awakening and for 30 minutes.(1:Obtunded with no response to stimulation, 2:Asleep but responsive to movement or stimulation, 3:Awake and responsive, 4:Crying, 5:Thrashing behaviour that requires restraint)
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Up to 30 minutes after surgery
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Emergence time
Time Frame: Up to 30 minutes after surgery
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Emergence time (min) is recorded; from the discontinuation of sevoflurane to the first response on verbal command.
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Up to 30 minutes after surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in heart rate
Time Frame: Up to the end of the surgery
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Heart rate (beat/min) is recorded at five-minute intervals until the end of the surgery.
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Up to the end of the surgery
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Changes in mean arterial blood pressure
Time Frame: Up to the end of the surgery
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Blood pressure (mmHg) is recorded at five-minute intervals until the end of the surgery.
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Up to the end of the surgery
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Incidence of oculocardiac reflex
Time Frame: Up to the end of the surgery
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If there is dysrhythmia or rapid reduction in HR by more than 25% from the baseline, it is considered as an oculocardiac reflex.
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Up to the end of the surgery
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Changes in pain scores
Time Frame: Up to 24 hours after the procedure
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Pain score from 0 to 10 (0 = no pain and 10 = the worst imaginable pain) is assessed every two hours up to 24 hours after the procedure.
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Up to 24 hours after the procedure
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Total analgesic requirements of paracetamol
Time Frame: Up to 24 hours after the procedure
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The amount of paracetamol consumption given as a rescue analgesia to patients is measured all over the 24 hours.
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Up to 24 hours after the procedure
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First analgesic request
Time Frame: Up to 24 hours after the procedure
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The time of the first analgesic request for paracetamol is recorded.
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Up to 24 hours after the procedure
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Incidence of postoperative nausea and vomiting
Time Frame: Up to 24 hours after the procedure
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Incidence of postoperative nausea and vomiting is assessed up to 24 hours after the procedure.
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Up to 24 hours after the procedure
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Collaborators and Investigators
Sponsor
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
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Nervous System Diseases
- Eye Diseases
- Postoperative Complications
- Neurologic Manifestations
- Confusion
- Neurobehavioral Manifestations
- Neurocognitive Disorders
- Dyskinesias
- Psychomotor Disorders
- Cranial Nerve Diseases
- Ocular Motility Disorders
- Delirium
- Psychomotor Agitation
- Strabismus
- Emergence Delirium
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics, General
- Platelet Aggregation Inhibitors
- Anesthetics, Inhalation
- Anesthetics
- Pharmaceutical Solutions
- Sevoflurane
- Anesthetics, Local
- Bupivacaine
Other Study ID Numbers
- Dexmedetomedine and agitation
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
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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