- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04659057
Nebulized Lidocaine, Dexmedetomedine and Their Combination in Direct Laryngoscopy Surgery
Effect of Nebulized Lidocaine, Dexmedetomedine and Their Combination on Haemodynamics During Direct Laryngoscopy Surgery. A Randomized Controlled Clinical Trial.
Study Overview
Status
Conditions
Detailed Description
Patients will be transferred to the induction room 30 min prior to surgery. Standard monitors will be applied [pulse oximetry, non invasive blood pressure (NIBP) and electrocardiogram (ECG)]. Basal HR, systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) will be recorded. An intravenous 22-G cannula will be inserted, and all patients will be pre-medicated with intravenous midazolam 0.02 mg/kg, granisetrone 2mg and ranitidine 30 mg.
Patients will then be randomly and evenly allocated to one of 4 groups (45 patients each).
Nebulized solutions will be prepared by a pharmacist not participating in the study. Nebulization will be done with 100% oxygen (10 L/min) through facemask attached to a nebulizer. Patients will be asked to breath normally. Nebulization will continue till the solution in the nebulizer is all aerosolized.
Upon arrival to the operating room, routine monitors will be applied in addition to neuromuscular monitor and end tidal CO2 (ETCO2). General anaesthesia will be induced, after 5 min of preoxygenation, by intravenous fentanyl 1 μg/kg, propofol 1.5-2 mg/kg titrated to a loss of verbal response and rocuronium 1 mg/kg to facilitate endotracheal intubation. Mackintosh laryngoscope will be introduced when train of four (TOF) count reaches 1. High volume-low pressure endotracheal tube (size 5-5.5) will be inserted by senior anaesthesiologist. HR, SBP, DBP and MAP will be recorded immediately after intubation.
Anaesthesia will be maintained by sevoflurane 2-3% in oxygen to air ratio 1:1. Rocuronium 0.1 mg/kg when required. Positive pressure ventilation will be set to maintain ETCO2 30-35 mmHg.
SBP, DBP, MAP and HR will be recorded on arrival to the induction room (baseline), after endotracheal intubation, and then every 5 min throughout the surgery.
In case of hypertension (defined as SBP > 140 mmHg, DBP >90 mmHg or MAP 20% higher than baseline) and/or tachycardia (defined as HR 20% higher than baseline), boluses fentanyl 0.5 μg/kg will be given with a maximum dose of 2 μg/Kg. If hypertension and/or tachycardia continue after reaching the maximum dose of fentanyl, loading dose of esmolol 500 μg/Kg will be started, followed by infusion of 100-300 μg/kg/min. The use and total dose of esmolol will be recorded.
In cases of significant hypotension (defined as mean blood pressure < 70 mmHg), the patient will be treated initially with an intravenous (IV) fluid bolus of10 mL/kg normal saline, and if the condition persists, the patient will given 0.1-0.3 mg/kg IV ephedrine, which will be repeated every 3-5 minutes until the blood pressure is normalized. Significant bradycardia (defined as heart rate < 60 beat/min) will be treated, when needed, with IV atropine 0.02 mg/kg.
At the conclusion of surgery, sevoflurane will be discontinued and patients will inhale 100% O2. After return of spontaneous breathing, residual neuromuscular block will be reversed with intravenous neostigmine 0.05 mg/kg and glycopyrolate 0.01 mg/kg. Extubation will be done when the patient starts to show purposeful movements.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
-
Cairo, Egypt, 11588
- Ain Shams University Hospitals
-
-
Cairo Governorate
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Cairo, Cairo Governorate, Egypt, 11566
- Ain Shams University
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ASA I-III patients admitted for DL surgery.
Exclusion Criteria:
- Uncontrolled hypertension (MAP > 100 mmHg) or ischaemic heart disease.
- End stage renal impairment.
- Chronic drug or alcohol abuse.
- Predicted difficult airway, laryngoscopy and intubation time > 30 sec, more than one attempt of intubation.
- Morbid obesity (BMI > 30).
- Known allergy to the drugs used.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Group L
Lidocaine group; 45 randomly assigned patients.
|
will receive nebulized lidocaine 2%, 1 mg/kg with a maximum dose of 100 mg (5 ml).
Other Names:
|
Active Comparator: Group D
Demedetomidine group; 45 randomly assigned patients.
|
will receive nebulized dexmedetomidine (1 μg/kg diluted in 5 ml of saline 0.9%).
Other Names:
|
Active Comparator: Group DL
Combined lidocaine and dexmedetomidine group.
45 randomly assigned patients.
|
will receive nebulized lidocaine 2% (0.5 mg/kg) and dexmedetomidine 0.5 μg/kg dexmedetomidine in 5 ml of saline 0.9%.
Other Names:
|
Placebo Comparator: Group C
Control group; 45 randomly assigned patients.
|
will receive nebulized saline 0.9% (5 ml) as control group.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Heart Rate
Time Frame: Every 5 minutes for 30-60minutes
|
Heart rate in beats/min
|
Every 5 minutes for 30-60minutes
|
Systolic blood pressure
Time Frame: Every 5 minutes for 30-60 minutes
|
Systolic blood pressure in mmHg
|
Every 5 minutes for 30-60 minutes
|
Diastolic blood pressure
Time Frame: Every 5 minutes for 30-60 minutes
|
Diastolic blood pressure in mmHg
|
Every 5 minutes for 30-60 minutes
|
Mean arterial pressure
Time Frame: Every 5 min for 30-60 minutes
|
Mean arterial pressure in mmHg
|
Every 5 min for 30-60 minutes
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total fentanyl and esmolol consumption
Time Frame: For 30-60 minutes
|
The total dose of fentanyl and/or esmolol consumed by each patient
|
For 30-60 minutes
|
recovery time
Time Frame: 5- 15 minutes
|
The time from discontinuation of anaesthetic drugs until response to verbal commands
|
5- 15 minutes
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Hala S El-Ozairy, MD, Ain Shams University
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
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Membrane Transport Modulators
- Hypnotics and Sedatives
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Dexmedetomidine
- Lidocaine
Other Study ID Numbers
- FMASU R 110/2020
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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