Alternative Sedation During Bronchoscopy

NCT ID: NCT01158820

Last Updated: 2019-02-26

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-06-30

Study Completion Date

2012-05-31

Brief Summary

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This protocol hopes to determine whether the use of dexmedetomidine-ketamine can reduce the use of standard of care fentanyl-midazolam sedation during bronchoscopy. This may result in less respiratory depression while providing better compliance with the procedure.

Detailed Description

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All patients enrolled in the study will be undergoing bronchoscopy, which is typically performed with sedation. All procedural sedation carries some risk. Several features of the study may lower the risk of sedation relative to that of conventional sedation. An anesthesiologist will be present throughout the procedure. Continuous monitoring of respiration with RIP will be employed. Administration of sedation will be via a volumetric syringe pump. Benefits specific to dexmedetomidine-ketamine include the lack of respiratory depression and greater hemodynamic stability.

Conditions

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Sedation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Placebo

midazolam load fentanyl load midazolam demand fentanyl demand benadryl demand

Group Type PLACEBO_COMPARATOR

Midazolam load

Intervention Type DRUG

2 mg bolus prior to bronchoscopy

Fentanyl load

Intervention Type DRUG

50 µg bolus prior to bronchoscopy

Midazolam demand

Intervention Type DRUG

0.5 mg demand bolus at discretion of pulmonologist

Fentanyl demand

Intervention Type DRUG

12.5 µg demand bolus at discretion of pulmonologist

Benadryl demand

Intervention Type DRUG

25 mg bolus after 6th and 13th demand midazolam/fentanyl bolus

dexmedetomidine and ketamine

dexmedetomidine load ketamine load dexmedetomidine maintenance ketamine maintenance midazolam demand fentanyl demand benadryl demand

Group Type ACTIVE_COMPARATOR

Dexmedetomidine load

Intervention Type DRUG

Dexmedetomidine 1 µg/kg prior to bronchoscopy

Ketamine load

Intervention Type DRUG

Ketamine 30 mg bolus prior to bronchoscopy

Dexmedetomidine maintenance

Intervention Type DRUG

0.5 µg/kg/hour for the duration of bronchoscopy (58.5 minutes average)

Ketamine maintenance

Intervention Type DRUG

8 µg/kg/min for the duration of bronchoscopy (58.5 minutes average)

Midazolam demand

Intervention Type DRUG

0.5 mg demand bolus at discretion of pulmonologist

Fentanyl demand

Intervention Type DRUG

12.5 µg demand bolus at discretion of pulmonologist

Benadryl demand

Intervention Type DRUG

25 mg bolus after 6th and 13th demand midazolam/fentanyl bolus

Interventions

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Dexmedetomidine load

Dexmedetomidine 1 µg/kg prior to bronchoscopy

Intervention Type DRUG

Ketamine load

Ketamine 30 mg bolus prior to bronchoscopy

Intervention Type DRUG

Midazolam load

2 mg bolus prior to bronchoscopy

Intervention Type DRUG

Fentanyl load

50 µg bolus prior to bronchoscopy

Intervention Type DRUG

Dexmedetomidine maintenance

0.5 µg/kg/hour for the duration of bronchoscopy (58.5 minutes average)

Intervention Type DRUG

Ketamine maintenance

8 µg/kg/min for the duration of bronchoscopy (58.5 minutes average)

Intervention Type DRUG

Midazolam demand

0.5 mg demand bolus at discretion of pulmonologist

Intervention Type DRUG

Fentanyl demand

12.5 µg demand bolus at discretion of pulmonologist

Intervention Type DRUG

Benadryl demand

25 mg bolus after 6th and 13th demand midazolam/fentanyl bolus

Intervention Type DRUG

Other Intervention Names

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Precedex Dexmedetomidine Hydrochloride Ketalar Calypsol Ketamin Ketaminol Ketanest Tekam Vetalar Versed Abstral Actiq Fentora Onsolis Precedex Dexmedetomidine Hydrochloride Ketalar Calypsol Ketamin Ketaminol Ketanest Tekam Vetalar Versed Abstral Actiq Fentora Onsolis Diphenhydramine Hcl Aler-Dryl Banophen Ben Tann Bromanate AF Diphen Diphenadryl Diphenhist Dytan Unisom Sominex Silphen Siladryl

Eligibility Criteria

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Inclusion Criteria

* Adults over the age of 18 scheduled for elective flexible bronchoscopy in the endoscopy suite or OR of HUP

Exclusion Criteria

* History of inability to complete bronchoscopy attributable to inadequate sedation
* Requiring more than 2 LPM supplemental oxygen to maintain SaO2 \> 90%
* History of allergy to study medications
* Pregnancy
* A history of psychosis
* Any condition deemed likely by the pulmonologist or anesthesiologist to pose a significant risk due to elevation of blood pressure, including cerebral/aortic aneurysm, and or ischemic cardiovascular disease
* Bradydysrhythmia deemed significant by the anesthesiologist or pulmonologist
* A diagnosis of significant renal or hepatic impairment
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 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 Pennsylvania

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jeff E Mandel, MD MS

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Locations

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University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Yarmus LB, Akulian JA, Gilbert C, Mathai SC, Sathiyamoorthy S, Sahetya S, Harris K, Gillespie C, Haas A, Feller-Kopman D, Sterman D, Lee HJ. Comparison of moderate versus deep sedation for endobronchial ultrasound transbronchial needle aspiration. Ann Am Thorac Soc. 2013 Apr;10(2):121-6. doi: 10.1513/AnnalsATS.201209-074OC.

Reference Type RESULT
PMID: 23607840 (View on PubMed)

Other Identifiers

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810981

Identifier Type: -

Identifier Source: org_study_id

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