Anesthesiological Strategies in Elective Craniotomy

NCT ID: NCT00741351

Last Updated: 2011-09-08

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

PHASE3

Total Enrollment

411 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-12-31

Study Completion Date

2009-12-31

Brief Summary

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This protocol, NeuroMorfeo, aims to assess equivalence between volatile and intravenous anesthetics for neurosurgical procedures.

Detailed Description

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NeuroMorfeo is a multicenter, randomized, open label, controlled trial, based on an equivalence design. Patients aged between 18 and 75 years, scheduled for a elective craniotomy for supratentorial lesion without signs of intracranial hypertension, in good physical state evaluated with the ASA (I-III) and Glasgow Coma Scale (GCS) equal to 15, will be randomly assigned to one of three anesthesiological strategies (two VA arms, sevoflurane + fentanyl or sevoflurane + remifentanil, and one IA, propofol + remifentanil). The equivalence between intravenous and volatile-based neuroanesthesia will be evaluated by comparing the intervals required to reach, after anesthesia discontinuation, a modified Aldrete score ≥ 9 (primary end-point). Two statistical comparisons have been planned: 1) sevoflurane + fentanyl vs. propofol + remifentanil; 2) sevoflurane + remifentanil vs. propofol + remifentanil.

Secondary end-points include: an assessment of neurovegetative stress based on (a) measurement urinary catecholamines and plasma and urinary cortisol and (b) estimate of sympathetic/parasympathetic balance by power spectrum analyses of electrocardiographic tracings recorded during anesthesia; intraoperative adverse events (i.e. hypotension, hypertension, requirement of osmotic agents or/and hyperventilation for controlling brain swelling); evaluation of surgical field; postoperative adverse events (as seizures, cough, shivering, agitation, postoperative hematoma and postoperative pain); patient's satisfaction and an analysis of costs.

411 patients will be recruited in 14 different Italian centers during an 18-month period.

The recruitment started December 20th, 2007 and up to 11th March 2009.

Conditions

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Anesthesia Craniotomy Neurosurgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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IF

Sevoflurane (Inhalation)+Fentanyl

Group Type EXPERIMENTAL

Sevoflurane + Fentanyl

Intervention Type DRUG

Sevoflurane is maintained in a MAC range (0.75% to 1.25%) and fentanyl (2-3 microg/kg/hr or 0.7 microg/kg boluses). Just before incision of the scalp, fentanyl (1-2microg/kg/hr) can be supplemented, if necessary

IR

Sevoflurane (Inhalation)+Remifentanyl

Group Type EXPERIMENTAL

Sevoflurane + Remifentanyl

Intervention Type DRUG

Sevoflurane is maintained in a MAC range (0.75% to 1.25%) and remifentanil (0.5-0.25 microg/kg/min reduced to 0.05-0.1 microg/kg/min after dural opening). Just before incision of the scalp, remifentanil can be supplemented, if necessary

ER

Propofol (Endovenous)+ Remifentanyl

Group Type EXPERIMENTAL

Propofol + Remifentanyl

Intervention Type DRUG

Propofol is maintained with continuous infusion at 10 mg/kg/h for the first 10 minutes, then reduced to 8 mg/kg/h for the following 10 minutes and reduced to 6mg/kg/h thereafter and remifentanil 0.5-0.25 microg/kg/min reduced to 0.05-0.1 microg/kg/min after dural opening. Just before incision of the scalp, remifentanil could be supplemented, if necessary

Interventions

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Sevoflurane + Fentanyl

Sevoflurane is maintained in a MAC range (0.75% to 1.25%) and fentanyl (2-3 microg/kg/hr or 0.7 microg/kg boluses). Just before incision of the scalp, fentanyl (1-2microg/kg/hr) can be supplemented, if necessary

Intervention Type DRUG

Sevoflurane + Remifentanyl

Sevoflurane is maintained in a MAC range (0.75% to 1.25%) and remifentanil (0.5-0.25 microg/kg/min reduced to 0.05-0.1 microg/kg/min after dural opening). Just before incision of the scalp, remifentanil can be supplemented, if necessary

Intervention Type DRUG

Propofol + Remifentanyl

Propofol is maintained with continuous infusion at 10 mg/kg/h for the first 10 minutes, then reduced to 8 mg/kg/h for the following 10 minutes and reduced to 6mg/kg/h thereafter and remifentanil 0.5-0.25 microg/kg/min reduced to 0.05-0.1 microg/kg/min after dural opening. Just before incision of the scalp, remifentanil could be supplemented, if necessary

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patient scheduled for elective intracranial surgery under general anesthesia for a supratentorial mass lesion in the next 24 hours;
* Physical state, evaluated with the ASA (American Society of Anesthesiologists ) classification I (normal healthy patient), II (patient with mild systemic disease), or III (patient with severe systemic disease);
* Age 18-75 years;
* Normal preoperative level of consciousness, i.e. Glasgow Coma Scale (GCS) = 15;
* No signs of intracranial hypertension.

Exclusion Criteria

* Severe cardiovascular pathology, as uncontrolled arterial hypertension, documented reduced coronary reserve.
* Renal or liver disease precluding the use of either anesthetic technique.
* Pregnancy .
* Known allergies to any anesthetic agent.
* Reduced preoperative level of consciousness, i.e.
* Glasgow Coma Scale (GCS) \< 15.
* Body weight greater than 120 kg.
* History of drug abuse or psychiatric conditions.
* Documented disturbance of the hypothalamic region.Refusal to sign consent form.
* Participation in other clinical trials.
* Delayed awakening, because, due to the location or size of the lesion, postoperative sedation and mechanical ventilation are planned.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Azienda Ospedaliera San Gerardo di Monza

OTHER

Sponsor Role lead

Responsible Party

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Dott. Giuseppe Citerio

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Giuseppe Citerio, MD

Role: PRINCIPAL_INVESTIGATOR

Azienda Ospedaliera San Gerardo Monza

Antonio Pesenti, MD

Role: STUDY_CHAIR

Università delgi Studi Milano Bicocca

Maria Grazia Franzosi, PhD

Role: STUDY_CHAIR

Istituto Di Ricerche Farmacologiche Mario Negri

Roberto Latini, MD

Role: STUDY_CHAIR

Istituto Di Ricerche Farmacologiche Mario Negri

Locations

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Policlinico Consorziale di Bari

Bari, , Italy

Site Status

Ospedale Bellaria Bologna

Bologna, , Italy

Site Status

IRCCS Fondazione San Raffaele Milano

Milan, , Italy

Site Status

Istituto di Ricerche Farmacologiche Mario Negri - Dipartimento di Ricerca Cardiovascolare-

Milan, , Italy

Site Status

Azienda Ospedaliera San Gerardo

Monza, , Italy

Site Status

Ospedale Maggiore della Carità di Novara

Novara, , Italy

Site Status

Ospedale di Padova

Padua, , Italy

Site Status

Azienda Ospedaliera di Parma

Parma, , Italy

Site Status

Policlinico "A. Gemelli" Roma

Rome, , Italy

Site Status

Policlinico "Umberto I" Roma

Rome, , Italy

Site Status

Azienda Universitaria Senese

Siena, , Italy

Site Status

Ospedale San Giovanni Bosco Torino

Turin, , Italy

Site Status

Ospedale San giovanni Battista Torino

Turin, , Italy

Site Status

Ospedale di Circolo e Fondazione Macchi Varese

Varese, , Italy

Site Status

Azienda Ospedaliera Universitaria di Verona

Verona, , Italy

Site Status

Countries

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Italy

References

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Other Identifiers

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AIFA FARM6FKJKK

Identifier Type: -

Identifier Source: secondary_id

EudraCT number 2007-005279-32

Identifier Type: -

Identifier Source: org_study_id

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