- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT00335972
The Effects of Dexmedetomidine and Remifentanil on Carotid Patients
Phase 4: The Effects of Dexmedetomidine and Remifentanil on Postoperative Hemodynamics and Pain/Opioids in Patients Undergoing Carotid Endarterectomy
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Remifentanil is an amidopiperidine derivative with unique pharmacokinetic properties. Its steady-state volume of distribution is 30 L (3). Its context-sensitive half life is consistently short (3.2 min), even after prolonged infusion(4). The pharmacokinetic profile of remifentanil is independent of the hepatic (5) and renal function (6). And finally, the recovery profile of remifentanil is excellent with a speedy anesthetic emergence time which is important for a quick and proper neurologic assessment in the early postoperative period.
Remifentanil produces good intraoperative hemodynamic control during intense noxious stimulation like laryngoscopy, endotracheal intubation, and during pinning of the head (8). However, side effects of remifentanil include hypotension and bradycardia (15) intraoperatively, along with apnea(16,17) and hyperalgesia(18) postoperatively which is caused by increasing sensitivity to noxious stimuli. Investigations demonstrate different mechanisms of opioid-induced post-infusion anti-analgesia and secondary hyperalgesia (9). Overall remifentanil is a versatile opioid that is being increasingly used in the operating room.
DEXMEDETOMIDINE (DEX), an alpha-2 adrenoreceptor agonist, is gaining popularity in neuroanesthesia. It has a desirable neurophysiologic profile including neuroprotective characteristics through its effect on α2A receptor subtypes (10). Its hypnotic effect is mediated through the α2 receptors in the locus ceruleus and its analgesic properties are mediated through an effect on the dorsal horn of the spinal cord (11,12). Since it has sympatholytic and antinociceptive properties, it may improve hemodynamic stability at critical moments of neurosurgical stimulation. Dexmedetomidine reduces anesthetic drug and opioid requirements in the perioperative period (13,14). In addition, dexmedetomidine does not affect evoked potential monitoring, (19) making it a favorable anesthetic adjunct in cases in which neurophysiologic monitoring is being used. In recent years, dexmedetomidine has emerged as an effective drug useful in a wide range of anesthesia related areas.
Study Questions We postulate that dexmedetomidine provides better hemodynamic control in the intra- and post-operative periods and reduces PACU analgesic requirements.
Primary Hypothesis 1: Intraoperative dexmedetomidine provides better postoperative analgesia than remifentanil, thus reducing PACU opioid requirements.
Primary Hypothesis 2: Dexmedetomidine causes fewer hemodynamic perturbations than remifentanil.
Studietyp
Inskrivning (Faktisk)
Fas
- Fas 4
Kontakter och platser
Studieorter
-
-
Ohio
-
Cleveland, Ohio, Förenta staterna, 44195
- Cleveland Clinic
-
-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Consenting adult patients (age >50 years) undergoing carotid endarterectomy with general anesthesia.
Exclusion Criteria:
- Receiving another alpha 2-adrenoreceptor agonist;
- Contraindication to dexmedetomidine, including allergy;
- Current hepatic disease (liver function tests > twice upper limit of normal);
- Renal insufficiency, as defined by a creatinine > 2.0 mg/dL;
- Mentally impairment, including dementia or delirium;
- Heart block ;
- Sick sinus syndrome;
- Atrial fibrillation with a low ventricular response (< 50 bpm);
- Absolute or relative hypovolemia;
- Prior stroke;
- Severe left-ventricular dysfunction
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Förebyggande
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Trippel
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Aktiv komparator: Remifentanil
Remifentanil will be infused throughout surgery at a rate of 0.1-0.2
µg/kg/min.
Propofol will be titrated to maintain a BIS value as close to 45 as clinically practical
|
Remifentanil will be infused throughout surgery at a rate of 0.1-0.2
µg/kg/min.
Propofol will be titrated to maintain a BIS value as close to 45 as clinically practical
|
Aktiv komparator: Dexmedetomidine
Dexmedetomidine, 0.5-1 µg/kg, will be infused over 20 minutes, immediately followed by an infusion at a rate of 0.2 µg/kg/hr until the end of surgery (For patients in renal failure, the loading dose will be 0.2 µg/kg).
The infusion rate will be reduced as necessary to maintain acceptable blood pressure and heart rate.
Propofol will be titrated to maintain BIS as close to 45 as clinically practical.
|
Dexmedetomidine, 0.5-1 µg/kg, will be infused over 20 minutes, immediately followed by an infusion at a rate of 0.2 µg/kg/hr until the end of surgery (For patients in renal failure, the loading dose will be 0.2 µg/kg).
The infusion rate will be reduced as necessary to maintain acceptable blood pressure and heart rate.
Propofol will be titrated to maintain BIS as close to 45 as clinically practical.
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Mean Arterial Pressure
Tidsram: mean arterial pressure at 15, 30, 45, 60, and 90 minutes after extubation
|
mean arterial pressure at 15, 30, 45, 60, and 90 minutes after extubation
|
|
Visual Analogue Scale (VAS) Pain Score
Tidsram: pain score measured at 15, 30, 45, 60, and 90 minutes after extubation
|
Using a ruler, the score is determined by measuring the distance on the 10-cm line between the "no pain" anchor and the patient's mark, providing a range of scores from 0-10.
0 = no pain and 10 = worst
|
pain score measured at 15, 30, 45, 60, and 90 minutes after extubation
|
Intravenous Morphine Equivalents During Post-anesthesia Care Unit (PACU) After Surgery
Tidsram: During Post-anesthesia care unit after surgery,an average of 4 hours
|
intravenous morphine equivalents (mg)
|
During Post-anesthesia care unit after surgery,an average of 4 hours
|
Samarbetspartners och utredare
Sponsor
Studieavstämningsdatum
Studera stora datum
Studiestart
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
Ytterligare relevanta MeSH-villkor
- Hjärt-kärlsjukdomar
- Kärlsjukdomar
- Cerebrovaskulära störningar
- Hjärnsjukdomar
- Sjukdomar i centrala nervsystemet
- Sjukdomar i nervsystemet
- Arteriella ocklusiva sjukdomar
- Carotidartärsjukdomar
- Carotisstenos
- Läkemedels fysiologiska effekter
- Adrenerga medel
- Neurotransmittormedel
- Molekylära mekanismer för farmakologisk verkan
- Depressiva medel i centrala nervsystemet
- Agenter från det perifera nervsystemet
- Analgetika
- Sensoriska systemagenter
- Analgetika, icke-narkotiska
- Adrenerga alfa-2-receptoragonister
- Adrenerga alfa-agonister
- Adrenerga agonister
- Analgetika, Opioid
- Narkotika
- Hypnotika och lugnande medel
- Remifentanil
- Dexmedetomidin
Andra studie-ID-nummer
- 10-27-05
Plan för individuella deltagardata (IPD)
Planerar du att dela individuella deltagardata (IPD)?
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