- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT06506669
Étude pilote de faisabilité sur les soins d'anesthésie surveillés pour la cataracte (MAC) (CaTNAPS-1)
Comparaison de deux approches normales de sédation procédurale pour la chirurgie de la cataracte : une étude pilote prospective de faisabilité
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Type d'étude
Inscription (Réel)
Phase
- N'est pas applicable
Contacts et emplacements
Lieux d'étude
-
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California
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San Francisco, California, États-Unis, 94143
- University of California, San Francisco
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
La description
Critère d'intégration:
- ≥ 65 ans
- Capable de fournir un consentement éclairé et de terminer les procédures d'étude en anglais
- Capable de donner son consentement pour soi-même
- Capable de suivre des instructions
- Capable de monter un escalier sans s'arrêter pour se reposer
- Avoir un nouveau diagnostic de cataracte
- Prévoyez de subir une opération de la cataracte à l’œil dans les 6 prochains mois
Critère d'exclusion:
- Antécédents de chirurgie de la cataracte
- Admission à l’hôpital au cours des 30 derniers jours
- Difficulté à être sous sédation lors d'autres procédures ambulatoires mineures ou d'études d'imagerie
- Allergie ou résistance aux agents anesthésiques locaux
- Vous ne pouvez pas vous allonger sur le dos sans présenter de symptômes (c'est-à-dire des difficultés respiratoires, de graves maux de dos, etc.)
- Antécédents d'anxiété sévère nécessitant l'utilisation systématique de benzodiazépines
- Maladie valvulaire grave (par exemple, sténose aortique critique)
- Conditions cardiaques nécessitant l'implantation d'un dispositif cardiaque tel qu'un stimulateur cardiaque, un défibrillateur ou un dispositif d'assistance ventriculaire gauche (pour l'arythmie, l'insuffisance cardiaque congestive, etc.)
- Douleur thoracique ou angine non traitée
- Patients souffrant de troubles du mouvement (par exemple, maladie de Parkinson)
- Antécédents d'accident vasculaire cérébral (AVC), d'accident ischémique transitoire (AIT) ou de convulsions
- Besoin d'oxygène à domicile (O2) au repos ou à l'effort
- Insuffisance rénale terminale (IRT) nécessitant une dialyse
- Obésité morbide (IMC>35)
- Patient subissant une opération de la cataracte en association avec toute autre procédure ophtalmologique
- Patient nécessitant une anesthésie générale pendant une opération de la cataracte en raison des caractéristiques sous-jacentes de la cataracte existante et/ou de la complexité anticipée de la procédure prévue
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Recherche sur les services de santé
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Quadruple
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: Intervention
Une sédation orale sera administrée aux patients avant la procédure.
|
Médicament oral pour l'anxiolyse administré en préopératoire
|
|
Comparateur placebo: Placebo
Une pilule placebo orale sera administrée aux patients avant la procédure.
|
Une pilule placebo sans principe actif administrée en préopératoire
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Number of Participants With High Satisfaction (ISAS Score ≥ 2)
Délai: 30 minutes (PACU), 1 day (POD1), and 7 days after surgery (POD7)
|
The Iowa Satisfaction with Anesthesia Scale (ISAS) is an 11-item validated questionnaire assessing patient satisfaction with anesthesia care. Each item is scored from -3 to +3, and the total score is calculated as the mean of all items, resulting in a total score range of -3 to +3. Higher scores indicate greater satisfaction. For this analysis, high satisfaction is defined as an ISAS score ≥ 2. |
30 minutes (PACU), 1 day (POD1), and 7 days after surgery (POD7)
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Number of Participants Meeting Eligibility Criteria at Screening
Délai: At screening (prior to enrollment)
|
Number of participants who met all eligibility criteria at the time of screening, out of the total number of participants assessed for eligibility
|
At screening (prior to enrollment)
|
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Number of Participants Completing All Study Surveys at Each Timepoint
Délai: 30 minutes (PACU), 1 day (POD1), and 7 days after surgery (POD7)
|
Number of participants who completed all required study surveys at each postoperative timepoint (PACU, POD1, POD7), out of the number of participants assigned to each study arm
|
30 minutes (PACU), 1 day (POD1), and 7 days after surgery (POD7)
|
|
Number of Participants Who Completed All Required Study Procedures
Délai: From enrollment through final study follow-up (POD7)
|
Number of participants who completed all required study procedures from enrollment through the final postoperative follow-up visit, out of the total number of participants enrolled in the study Instruments: Iowa Satisfaction with Anesthesia Scale (ISAS) Postoperative Quality of Recovery Scale (PQRS) Quality of Recovery-15 (QoR-15) Functional Recovery Index (FRI) |
From enrollment through final study follow-up (POD7)
|
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Number of Participants With Sedation-Related Complications During 30-Day Postoperative Follow-up
Délai: From enrollment through 30 days after surgery
|
Number of participants experiencing at least one sedation-related complication within 30 days after surgery, out of the total number of participants enrolled in the study
|
From enrollment through 30 days after surgery
|
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Number of Participants Achieving Recovery on the Postoperative Quality of Recovery Scale (PQRS)
Délai: 30 minutes (PACU), 1 day (POD1), and 7 days after surgery (POD7)
|
The Postoperative Quality of Recovery Scale (PQRS) assesses recovery across physiological, pain, emotional, cognitive, and activities of daily living domains. For this analysis, recovery is defined as meeting PQRS recovery criteria at each time point. Recovery is defined as a return to baseline performance in all assessed PQRS domains at each time point. |
30 minutes (PACU), 1 day (POD1), and 7 days after surgery (POD7)
|
|
Quality of Recovery-15 (QoR-15) Total Score After Surgery
Délai: 1 day and 7 days after surgery
|
The Quality of Recovery-15 (QoR-15) is a validated 15-item questionnaire assessing postoperative recovery across physical comfort, emotional state, psychological support, and physical independence.
Each item is scored from 0 to 10, and the total score is calculated by summing all items, resulting in a total score range of 0 to 150.
Higher scores indicate better recovery.
|
1 day and 7 days after surgery
|
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Functional Recovery Index (FRI) Total Score After Surgery
Délai: 1 day and 7 days after surgery
|
The Functional Recovery Index (FRI) is a validated 14-item questionnaire assessing postoperative functional recovery, including mobility and activities of daily living.
Each item is scored and summed to produce a total score ranging from 0 to 100.
Lower scores indicate better functional recovery.
|
1 day and 7 days after surgery
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Catherine L Chen, M.D., University of California, San Francisco
Publications et liens utiles
Publications générales
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- Chen CL, Lin GA, Bardach NS, Clay TH, Boscardin WJ, Gelb AW, Maze M, Gropper MA, Dudley RA. Preoperative medical testing in Medicare patients undergoing cataract surgery. N Engl J Med. 2015 Apr 16;372(16):1530-8. doi: 10.1056/NEJMsa1410846.
- McIsaac DI, MacDonald DB, Aucoin SD. Frailty for Perioperative Clinicians: A Narrative Review. Anesth Analg. 2020 Jun;130(6):1450-1460. doi: 10.1213/ANE.0000000000004602.
- Chen CL, Clay TH, McLeod S, Chang HP, Gelb AW, Dudley RA. A Revised Estimate of Costs Associated With Routine Preoperative Testing in Medicare Cataract Patients With a Procedure-Specific Indicator. JAMA Ophthalmol. 2018 Mar 1;136(3):231-238. doi: 10.1001/jamaophthalmol.2017.6372.
- Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet. 2017 Aug 5;390(10094):600-612. doi: 10.1016/S0140-6736(17)30544-5. Epub 2017 Feb 25.
- Norregaard, J. C. Results from the International Cataract Surgery Outcomes Study. Acta Ophthalmologica Scandinavica 85, 5-32, doi:10.1111/j.1600-0420.2007.00937.x (2007).
- Kent, C. Cataract Surgery: Is an anesthesiologist necessary?, <https://www.reviewofophthalmology.com/article/cataract-surgery-is-an-anesthesiologist-necessary> (2009).
- Andrews, M. Anthem Calls On Eye Surgeons To Monitor Anesthesia During Cataract Surgery, <https://khn.org/news/anthem-calls-on-eye-surgeons-to-monitor-anesthesia-during-cataract-surgery/> (2018).
- Zakrzewski PA, Friel T, Fox G, Braga-Mele R. Monitored anesthesia care provided by registered respiratory care practitioners during cataract surgery: a report of 1957 cases. Ophthalmology. 2005 Feb;112(2):272-7. doi: 10.1016/j.ophtha.2004.08.016.
- Kent-Smith BT, Wallace GM. Routine cataract surgery without the presence of an anaesthetist. Clin Exp Ophthalmol. 2007 Aug;35(6):589. doi: 10.1111/j.1442-9071.2007.01553.x. No abstract available.
- Murray P, Adams K, Haddad P, Murray N, O'Rourke M. The routine requirement for anaesthetists in local anaesthetic cataract surgery. Clin Exp Ophthalmol. 2007 Mar;35(2):195-6. doi: 10.1111/j.1442-9071.2006.01441.x. No abstract available.
- Zakrzewski PA, Banashkevich AV, Friel T, Braga-Mele R. Monitored anesthesia care by registered respiratory therapists during cataract surgery: an update. Ophthalmology. 2010 May;117(5):897-902. doi: 10.1016/j.ophtha.2009.10.005. Epub 2010 Jan 15.
- Basta B, Gioia L, Gemma M, Dedola E, Bianchi I, Fasce F, Beretta L. Systemic adverse events during 2005 phacoemulsifications under monitored anesthesia care: a prospective evaluation. Minerva Anestesiol. 2011 Sep;77(9):877-83.
- Koolwijk J, Fick M, Selles C, Turgut G, Noordergraaf JI, Tukkers FS, Noordergraaf GJ. Outpatient cataract surgery: incident and procedural risk analysis do not support current clinical ophthalmology guidelines. Ophthalmology. 2015 Feb;122(2):281-7. doi: 10.1016/j.ophtha.2014.08.030. Epub 2014 Oct 22.
- Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG, Fleisher LA, Schein OD. Injectable versus topical anesthesia for cataract surgery: patient perceptions of pain and side effects. The Study of Medical Testing for Cataract Surgery study team. Ophthalmology. 2000 Nov;107(11):2054-60. doi: 10.1016/s0161-6420(00)00359-6.
- Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG, Fleisher LA, Schein OD; Study of Medical Testing for Cataract Surgery Study Team. Adverse intraoperative medical events and their association with anesthesia management strategies in cataract surgery. Ophthalmology. 2001 Oct;108(10):1721-6. doi: 10.1016/s0161-6420(01)00704-7.
- Fukuoka H, Afshari NA. The impact of age-related cataract on measures of frailty in an aging global population. Curr Opin Ophthalmol. 2017 Jan;28(1):93-97. doi: 10.1097/ICU.0000000000000338.
- American Society of Anesthesiologists. ASA Calls on Anthem to Rescind Its New Policy on Anesthesia for Cataract Surgery, <https://www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2018/02/asa-calls-on-anthem-to-rescind-its-new-policy-on-anesthesia-for-cataract-surgery?&ct=fd2b35b6cdb74e0b126f4539b73b56360091233e85002bc197d8049fa56b7a4253b022b37557ad25186cfc15475fa96cd09811e97c66fe62b04a1ec1298f82ef> (2018).
- American Academy of Ophthalmology. Pressure on Anthem Grows; Academy Keeps Pushing for Cataract-Surgery Anesthesia Coverage, 2018).
- Hubbard RE, Story DA. Patient frailty: the elephant in the operating room. Anaesthesia. 2014 Jan;69 Suppl 1:26-34. doi: 10.1111/anae.12490.
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- Stein JD, Grossman DS, Mundy KM, Sugar A, Sloan FA. Severe adverse events after cataract surgery among medicare beneficiaries. Ophthalmology. 2011 Sep;118(9):1716-23. doi: 10.1016/j.ophtha.2011.02.024. Epub 2011 Jun 2.
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- California Medical Association. CMA calls for investigation into Anthem restricting use of sedation during cataract surgery, <https://www.cmadocs.org/newsroom/news/view/ArticleID/21466/t/CMA-calls-for-investigation-into-Anthem-policy-restricting-use-of-sedation-during-cataract-surgery> (2018).
- Whitlock EL, Whittington RA. The Frailty Syndrome: Anesthesiologists Must Understand More and Fear Less. Anesth Analg. 2020 Jun;130(6):1445-1448. doi: 10.1213/ANE.0000000000004789. No abstract available.
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Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 23-40367
- 5K23AG072035-03 (Subvention/contrat des NIH des États-Unis)
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
Informations sur les médicaments et les dispositifs, documents d'étude
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