Influence of Dexmedetomidine on the Evoked Potentials During Spine Surgery

NCT ID: NCT00494832

Last Updated: 2012-09-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-02-29

Study Completion Date

2010-05-31

Brief Summary

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The purposes of this study are:

1. To evaluate the safety and efficacy of Dexmedetomidine as an adjunct for anesthesia during spine surgery and
2. To investigate the influence of Dexmedetomidine on the evoked potentials.

Detailed Description

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Use of evoked potentials can significantly improve neurologic outcome after major spine surgery. Modalities of evoked potentials commonly used are Somato-Sensory Evoked Potentials (SSEP's), Motor Evoked Potentials (MEP's), and Visual Evoked Potentials (VEP's).

Dexmedetomidine (DEX) is an alpha-2 agonist and has been FDA approved as an adjunct sedative agent to general anesthesia. It has been purported to reduce the amount of anesthetic required and potentiate the analgesic effect of opiates. In addition, DEX was shown to have minimal effect on SSEP's and VEP's in both rats and humans. Any decrease in the dose of general anesthesia that improves the monitoring of evoked potentials, supports DEX as an adjunct.

It is known that all anesthetic agents can interfere with the recording of evoked potentials. The choice of anesthetic however, depends on the modality of neurophysiologic monitoring planned for the patient. Total intravenous anesthesia (TIVA) and Sevoflurane, a low dose inhalational anesthetic are the usual agents for spine surgery. Both have a dose-related depressant effect on the quality of evoked potentials. As a result, it is common practice for the anesthesiologist to adjust the depth of anesthesia to improve signaling. The use of either anesthetic must accompany continuous infusion of Propofol and an opioid, Remifentanil or Fentanyl. The anesthesiologist then decides whether DEX should be as an adjunct. In our experience, DEX did not impair evoked potentials. In fact, it improved the quality of signals in a few patients. Yet, there are no published data of such effects in medical literature.

We hypothesize that Dexmedetomidine will not influence evoked potentials when used as an adjunct to general anesthesia. Our study is prospective, randomized, double-blinded and will be carried out on a set of anesthetics. We will first evaluate DEX as an adjunct in TIVA, then as an adjunct to Sevoflurane. The probable benefit of DEX may avoid the use of potent inhaled anesthetics which would improve VEP's monitoring. Quality recording of evoked potentials can enhance our ability to detect iatrogenic injury to the spinal cord and vision.

Conditions

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Spine Surgery

Keywords

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Dexmedetomidine Evoked potentials Spine surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Dexmedetomidine

Dexmedetomidine infusion

Group Type ACTIVE_COMPARATOR

Dexmedetomidine

Intervention Type DRUG

10 minutes loading dose of 0.9 mcg/kg

Maintenance dose of 0.6 mcg/kg/hour

Placebo

Normal Saline infusion

Group Type PLACEBO_COMPARATOR

Normal Saline

Intervention Type DRUG

10 minutes loading dose of 0.9 mcg/kg

Maintenance dose of 0.6 mcg/kg/hour

Interventions

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Dexmedetomidine

10 minutes loading dose of 0.9 mcg/kg

Maintenance dose of 0.6 mcg/kg/hour

Intervention Type DRUG

Normal Saline

10 minutes loading dose of 0.9 mcg/kg

Maintenance dose of 0.6 mcg/kg/hour

Intervention Type DRUG

Other Intervention Names

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Dexmedetomidine hydrochloride 0.9% Sodium Chloride

Eligibility Criteria

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Inclusion Criteria

* Adult spine surgery patients requiring evoked potentials monitoring.

Exclusion Criteria

* Age younger than 18 and older than 80 years
* Patients with moderate neurological deficit
* ASA grade above 3
* Any chronic psychiatric disorder
* Body mass index (BMI) above 35
* Patients with cortical blindness, cataracts, retinal or optic neuropathy, glaucoma, untreated diabetes, active hepatitis, active coronary artery disease, untreated arrhythmias and patients with renal or hepatic insufficiency
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospira, now a wholly owned subsidiary of Pfizer

INDUSTRY

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Irene Rozet, MD

Role: PRINCIPAL_INVESTIGATOR

University of Washington

Locations

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Harborview Medical Center

Seattle, Washington, United States

Site Status

University of Washington Medical Center

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Rozet I, Metzner J, Brown M, Treggiari MM, Slimp JC, Kinney G, Sharma D, Lee LA, Vavilala MS. Dexmedetomidine Does Not Affect Evoked Potentials During Spine Surgery. Anesth Analg. 2015 Aug;121(2):492-501. doi: 10.1213/ANE.0000000000000840.

Reference Type DERIVED
PMID: 26097987 (View on PubMed)

Other Identifiers

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064705 A01

Identifier Type: OTHER

Identifier Source: secondary_id

31416-A

Identifier Type: -

Identifier Source: org_study_id