Transition From Sevoflurane to Total Intravenous Anesthesia in Pediatric Patients (TSTP)
Observational Analysis of the Transition From Inhalational Anesthesia to Total Intravenous Anesthesia Guided by Bispectral Index and the Eleveld Model in Pediatric Patients
Studieoversigt
Status
Status
Betingelser
Betingelser
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Manuel Cuevas, MD
- Telefonnummer: 542494675554
- E-mail: manuel.cuevas@anestesiologo.org
Undersøgelse Kontakt Backup
- Navn: Stella Verlangieri, MD
- Telefonnummer: 541144905757
- E-mail: sverlangieri@gmail.com
Studiesteder
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C.a.b.a.
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C.a.b.a., C.a.b.a., Argentina, 1270
- Hospital General de Niños Pedro de Elizalde
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Kontakt:
- Gonzalo Alberto Tejeda, MD
- Telefonnummer: +54 9 2314 47-3867
- E-mail: gonzalotejedamed@gmail.com
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Kontakt:
- Nicolas Alejandro Rzza, MD
- Telefonnummer: +54 9 11 6010-7126
- E-mail: nicolas.alejandro.rizza@gmail.com
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Ledende efterforsker:
- Gonzalo Alberto Tejeda, MD
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Underforsker:
- Nicolas Alejandro Rizza, MD
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C.a.b.a., C.a.b.a., Argentina, 1881
- Hospital de Clinicas Jose de San Martin
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Kontakt:
- Manuel Cuevas, MD
- Telefonnummer: 02494675554
- E-mail: manuel.cuevas@anestesiologo.org
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Kontakt:
- Stella Verlangieri, MD
- Telefonnummer: 54 9 11 4490-5757
- E-mail: sverlangieri@gmail.com
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Underforsker:
- Francisco Bornet, MD
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Barn
Tager imod sunde frivillige
Prøveudtagningsmetode
Studiebefolkning
Beskrivelse
Inclusion Criteria:
- Age 2 to 12 years
- Scheduled for elective low- or intermediate-risk surgery according to the National Institute for Health and Care Excellence (NICE) surgical risk stratification (e.g., tonsillectomy, adenoidectomy, postioplasty, orchidectomy, orchidopexy, inguinal herniorrhaphy)
- American Society of Anesthesiologists (ASA) Physical Status Classification I or II
Exclusion Criteria:
- Refusal of parents/legal guardians to sign informed consent, or refusal of the child to provide assent when applicable
- Cardiovascular or neurological disease that may interfere with anesthesia or with the pharmacokinetic model
- History of allergy or adverse reaction to inhalational or intravenous anesthetic agents used in the protocol
- Airway malformations or conditions that complicate standard intubation or airway management
- Psychological or neurological conditions requiring sedative or hypnotic premedication prior to the anesthetic procedure
- Treatment with drugs that may alter the pharmacokinetics or pharmacodynamics of the anesthetic agents
- Difficult peripheral venous access
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
Antal grupper/kohorter
Kohorter og interventioner
Gruppe / kohorteGruppe / kohorte |
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Pediatric patients undergoing sevoflurane to TIVA transition
Pediatric patients aged 2-12 years scheduled for elective low or intermediate risk surgery, undergoing standard sevoflurane mask induction followed by transition to total intravenous anesthesia with propofol via target-controlled infusion (Eleveld model) and remifentanil, guided by Bispectral Index monitoring.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Temporal evolution of propofol effect-site concentration under Eleveld-model TCI during anesthetic transition
Tidsramme: From start of propofol infusion (T0, when sevoflurane MAC = 1.0 for age), until sevoflurane MAC = 0, or a maximum of 15 minutes, whichever occurs first.
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Pattern of propofol effect-site concentration (Ce) adjustments (mcg/mL) over time during the transition from sevoflurane inhalation anesthesia to TIVA.
Propofol is administered via target-controlled infusion using the Eleveld pharmacokinetic-pharmacodynamic model with adjustment for opioid co-administration.
Ce values are titrated under BIS-guided monitoring to maintain BIS between 40 and 60, as a function of decreasing sevoflurane minimum alveolar concentration.
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From start of propofol infusion (T0, when sevoflurane MAC = 1.0 for age), until sevoflurane MAC = 0, or a maximum of 15 minutes, whichever occurs first.
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Interindividual variability in propofol titration
Tidsramme: Throughout the transition period (up to 15 minutes from start of propofol infusion)
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Distribution of propofol effect-site concentration values required to maintain target BIS, expressed as mean, SD, median, and IQR across patients.
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Throughout the transition period (up to 15 minutes from start of propofol infusion)
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Time to reach target BIS range (40-60)
Tidsramme: Up to 15 minutes from start of propofol infusion.
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Time elapsed from start of propofol infusion until BIS first reaches 40-60 (minutes).
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Up to 15 minutes from start of propofol infusion.
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Time outside target BIS range
Tidsramme: Up to 15 minutes from start of propofol infusion
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Cumulative time with BIS <40 and BIS >60 during transition (minutes).
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Up to 15 minutes from start of propofol infusion
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Duration of cortical suppression episodes
Tidsramme: Up to 15 minutes from start of propofol infusion
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Total time with EEG suppression detected by BIS monitor (minutes).
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Up to 15 minutes from start of propofol infusion
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Spectral edge frequency (SEF) and median frequency (MF) over time
Tidsramme: Up to 15 minutes from start of propofol infusion
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Time course of SEF and MF (Hz) recorded minute by minute from processed EEG.
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Up to 15 minutes from start of propofol infusion
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Incidence of intraoperative hemodynamic adverse events
Tidsramme: Up to 15 minutes from start of propofol infusion
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Frequency of hypotension (≥20% drop in MAP from baseline), hypertension (≥20% rise in MAP from baseline), bradycardia (HR below age-adjusted normal range), and tachycardia (HR above age-adjusted normal range).
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Up to 15 minutes from start of propofol infusion
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Manuel Cuevas, MD, Hospital de Clinicas Jose de San Martin
Publikationer og nyttige links
Generelle publikationer
- Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures. Anesthesiology. 2015 Oct;123(4):937-60. doi: 10.1097/ALN.0000000000000841.
- Lee JM, Akeju O, Terzakis K, Pavone KJ, Deng H, Houle TT, Firth PG, Shank ES, Brown EN, Purdon PL. A Prospective Study of Age-dependent Changes in Propofol-induced Electroencephalogram Oscillations in Children. Anesthesiology. 2017 Aug;127(2):293-306. doi: 10.1097/ALN.0000000000001717.
- Degoute CS, Macabeo C, Dubreuil C, Duclaux R, Banssillon V. EEG bispectral index and hypnotic component of anaesthesia induced by sevoflurane: comparison between children and adults. Br J Anaesth. 2001 Feb;86(2):209-12. doi: 10.1093/bja/86.2.209.
- McFarlan CS, Anderson BJ, Short TG. The use of propofol infusions in paediatric anaesthesia: a practical guide. Paediatr Anaesth. 1999;9(3):209-16.
- Kreuer S, Wilhelm W. The Narcotrend monitor. Best Pract Res Clin Anaesthesiol. 2006 Mar;20(1):111-9. doi: 10.1016/j.bpa.2005.08.010.
- Eleveld DJ, Colin P, Absalom AR, Struys MMRF. Pharmacokinetic-pharmacodynamic model for propofol for broad application in anaesthesia and sedation. Br J Anaesth. 2018 May;120(5):942-959. doi: 10.1016/j.bja.2018.01.018. Epub 2018 Mar 12.
- Nimmo AF, Absalom AR, Bagshaw O, Biswas A, Cook TM, Costello A, Grimes S, Mulvey D, Shinde S, Whitehouse T, Wiles MD. Guidelines for the safe practice of total intravenous anaesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia. Anaesthesia. 2019 Feb;74(2):211-224. doi: 10.1111/anae.14428. Epub 2018 Oct 31.
- Vellinga R, Hannivoort LN, Introna M, Touw DJ, Absalom AR, Eleveld DJ, Struys MMRF. Prospective clinical validation of the Eleveld propofol pharmacokinetic-pharmacodynamic model in general anaesthesia. Br J Anaesth. 2021 Feb;126(2):386-394. doi: 10.1016/j.bja.2020.10.027. Epub 2020 Dec 13.
- Eleveld DJ, Proost JH, Vereecke H, Absalom AR, Olofsen E, Vuyk J, Struys MMRF. An Allometric Model of Remifentanil Pharmacokinetics and Pharmacodynamics. Anesthesiology. 2017 Jun;126(6):1005-1018. doi: 10.1097/ALN.0000000000001634.
- Dennhardt N, Boethig D, Beck C, Heiderich S, Boehne M, Leffler A, Schultz B, Sumpelmann R. Optimization of initial propofol bolus dose for EEG Narcotrend Index-guided transition from sevoflurane induction to intravenous anesthesia in children. Paediatr Anaesth. 2017 Apr;27(4):425-432. doi: 10.1111/pan.13118. Epub 2017 Feb 18.
- Davidson AJ, Sale SM, Wong C, McKeever S, Sheppard S, Chan Z, Williams C. The electroencephalograph during anesthesia and emergence in infants and children. Paediatr Anaesth. 2008 Jan;18(1):60-70. doi: 10.1111/j.1460-9592.2007.02359.x.
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- PED-TIVA-TRANS
- TSTP01 (Anden identifikator: Hospital de Clínicas José de San Martín)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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