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The Effects of Midazolam, Dexmedetomidine, and Esketamine on Bispectral Index and Raw Electroencephalogram in Patients Under Propofol-Remifentanil Baseline Anesthesia

8. juli 2026 opdateret af: Li Zhao, China-Japan Friendship Hospital

This prospective, single-center, randomized interventional study aims to investigate the effects of commonly used adjunct anesthetic drugs on the Bispectral Index (BIS) and electroencephalographic (EEG) activity during total intravenous anesthesia.

BIS monitoring is widely used to estimate the depth of anesthesia. However, previous studies suggest that certain anesthetic drugs, particularly dexmedetomidine and esketamine, may alter BIS values independently of the patient's actual level of consciousness. As a result, BIS readings may not always accurately reflect anesthetic depth when multiple drugs are administered together.

Adult patients undergoing elective laparoscopic cholecystectomy under standardized propofol-remifentanil anesthesia will be randomly assigned to receive one of the following adjunct drugs: midazolam, dexmedetomidine, esketamine, or no additional study drug (control group). Continuous BIS values and raw EEG signals will be recorded throughout the study period.

The primary objective is to compare changes in BIS values among different adjunct anesthetic drugs under otherwise similar anesthetic conditions. The study will also explore corresponding EEG characteristics associated with these changes. The findings are expected to improve understanding of drug-related differences in processed EEG monitoring and provide data for future development of more accurate anesthesia depth assessment methods.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

120

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • Beijing Municipality
      • Beijing, Beijing Municipality, Kina, 100029
        • China-Japan Friendship Hospital
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  1. ASA physical status I-II;
  2. BMI 18-28 kg/m²;
  3. Scheduled for elective laparoscopic cholecystectomy, with an expected surgical duration from skin incision to completion of wound closure of ≥45 min;
  4. Planned to receive propofol-remifentanil total intravenous anesthesia, with routine intraoperative BIS monitoring and simultaneous acquisition of raw EEG signals;
  5. Voluntarily agrees to participate in this study, has signed the informed consent form, and is able to cooperate with the intervention and assessment procedures.

Exclusion Criteria:

  1. A confirmed history of psychiatric or neurological disorders, or use of antipsychotics, antidepressants, benzodiazepines, or other sedative-hypnotic drugs within 4 weeks before surgery;
  2. Cognitive impairment identified by Mini-Cog screening;
  3. Poorly controlled or untreated hypertension, sinus bradycardia, or severe cardiac conduction block;
  4. Acute angle-closure glaucoma;
  5. Known allergy to any required anesthetic drug;
  6. Difficulty in electrode placement or any condition that may interfere with EEG monitoring.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Diagnostisk
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Control Group
Participants receive standardized propofol-remifentanil total intravenous anesthesia without administration of the study adjunct anesthetic drug.
Propofol will be administered as part of standardized total intravenous anesthesia in all study groups.
Remifentanil will be administered as part of standardized total intravenous anesthesia in all study groups.
Eksperimentel: Midazolam Group
Participants receive standardized propofol-remifentanil total intravenous anesthesia plus midazolam according to the study protocol.
Propofol will be administered as part of standardized total intravenous anesthesia in all study groups.
Remifentanil will be administered as part of standardized total intravenous anesthesia in all study groups.
Midazolam administered as an adjunct to standardized propofol-remifentanil total intravenous anesthesia according to the study protocol.
Eksperimentel: Dexmedetomidine Group
Participants receive standardized propofol-remifentanil total intravenous anesthesia plus dexmedetomidine according to the study protocol.
Propofol will be administered as part of standardized total intravenous anesthesia in all study groups.
Remifentanil will be administered as part of standardized total intravenous anesthesia in all study groups.
Dexmedetomidine administered as an adjunct to standardized propofol-remifentanil total intravenous anesthesia according to the study protocol.
Eksperimentel: Esketamine Group
Participants receive standardized propofol-remifentanil total intravenous anesthesia plus esketamine according to the study protocol.
Propofol will be administered as part of standardized total intravenous anesthesia in all study groups.
Remifentanil will be administered as part of standardized total intravenous anesthesia in all study groups.
Esketamine administered as an adjunct to standardized propofol-remifentanil total intravenous anesthesia according to the study protocol.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in Bispectral Index (BIS) value from the pre-intervention baseline
Tidsramme: Baseline and 5, 10, 15, 20, 25, 30 minutes after adjunct drug administration
Change in Bispectral Index value from the stable pre-intervention baseline will be compared among the four study groups after administration of the assigned adjunct anesthetic drug under standardized propofol-remifentanil total intravenous anesthesia. The pre-intervention baseline is defined as the stable BIS value immediately before administration of the assigned adjunct anesthetic drug. The Bispectral Index is a dimensionless electroencephalography-derived index ranging from 0 to 100, with lower values indicating deeper hypnotic states.
Baseline and 5, 10, 15, 20, 25, 30 minutes after adjunct drug administration

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in mean arterial pressure from pre-intervention baseline
Tidsramme: Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.
Change in mean arterial pressure (MAP) from the stable pre-intervention baseline will be compared among the four study groups after administration of the assigned adjunct anesthetic drug under standardized propofol-remifentanil total intravenous anesthesia.
Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.
Change in heart rate from pre-intervention baseline
Tidsramme: Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.
Change in heart rate (HR) from the stable pre-intervention baseline will be compared among the four study groups after administration of the assigned adjunct anesthetic drug.
Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.
Time from discontinuation of anesthetic drugs to airway device removal
Tidsramme: From discontinuation of anesthetic drugs to airway device removal, up to 60 minutes.
The time interval from discontinuation of anesthetic drugs to removal of the airway device will be recorded.
From discontinuation of anesthetic drugs to airway device removal, up to 60 minutes.
Time to Aldrete score of 10 in the post-anesthesia care unit
Tidsramme: From admission to the post-anesthesia care unit to achievement of an Aldrete score of 10, up to 2 hours.
The time from admission to the post-anesthesia care unit to achievement of an Aldrete score of 10 will be recorded. The Aldrete score ranges from 0 to 10, with higher scores indicating better post-anesthesia recovery.
From admission to the post-anesthesia care unit to achievement of an Aldrete score of 10, up to 2 hours.
Brice questionnaire assessment
Tidsramme: Before discharge from the post-anesthesia care unit, and at 24 and 48 hours after surgery.
The Brice questionnaire will be used to assess postoperative recall and awareness-related events.
Before discharge from the post-anesthesia care unit, and at 24 and 48 hours after surgery.
Postoperative pain score
Tidsramme: At admission to the post-anesthesia care unit, before discharge from the post-anesthesia care unit, and at 24 and 48 hours after surgery.
Postoperative pain intensity will be assessed using the numeric rating scale (NRS).
At admission to the post-anesthesia care unit, before discharge from the post-anesthesia care unit, and at 24 and 48 hours after surgery.
Postoperative analgesic medication use
Tidsramme: From admission to the post-anesthesia care unit to 48 hours after surgery.
Use of postoperative analgesic medications, including opioid and non-opioid analgesics (e.g., NSAIDs), in the post-anesthesia care unit and hospital ward will be recorded and compared among study groups.
From admission to the post-anesthesia care unit to 48 hours after surgery.

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in pre-specified electroencephalographic spectral features from baseline
Tidsramme: Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.
Pre-specified electroencephalographic spectral features, including alpha-to-delta power ratio, frontal alpha power, alpha peak frequency, and burst suppression ratio, will be evaluated and compared among study groups at baseline and after administration of the assigned adjunct anesthetic drug.
Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.
Change in electroencephalographic relative spectral power from baseline
Tidsramme: Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.
Relative power spectral density of delta, theta, alpha, beta, and gamma frequency bands will be compared among study groups at baseline and after administration of the assigned adjunct anesthetic drug.
Baseline and 5, 10, 15, 20, 25, and 30 minutes after adjunct drug administration.

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Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

30. juni 2026

Primær færdiggørelse (Anslået)

30. juni 2027

Studieafslutning (Anslået)

30. december 2027

Datoer for studieregistrering

Først indsendt

26. juni 2026

Først indsendt, der opfyldte QC-kriterier

8. juli 2026

Først opslået (Faktiske)

13. juli 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

13. juli 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

8. juli 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • 2026-HX-40

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