Isoflurane Versus Propofol for Removal of LMA in Children

NCT ID: NCT01958138

Last Updated: 2021-02-15

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

PHASE2/PHASE3

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-04-30

Study Completion Date

2013-11-30

Brief Summary

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The study will be done in paediatric patients by comparing two different techniques of Laryngeal Mask Airway (LMA) removal under deep anesthetic plane.

The both study techniques will be compared for safe LMA removal on the basis of adverse airway events and emergence time duration and recovery room stay timing.

Detailed Description

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* Study will be start after confirming the approval of institutional ethical review committee and after fulfilling the study inclusion criteria. The detailed study protocol will be explain to the parent/guardian and written \& informed consent will be taking on his/her will.
* Inclusion Criteria

* Age between 2 to 10 years,
* American Society of Anaesthesiologists (ASA) physical status I \& II,
* Patient is not contraindicated to Laryngeal Mask Airway insertion,
* Elective below umbilical general surgical procedures
* patient is planned for general anesthesia with spontaneous breathing.
* Fifty patients will participate in both study groups.
* All patients will be premedicated with oral midazolam 0.3mg/kg, 45 to 60 minutes prior to induction.
* After arrival of patients in operating room, routine anesthesia monitoring will be applied and baseline blood pressure, heart rate, respiratory rate and oxygen saturation will be recorded.
* Patient will be induced with anesthetic induction inhalational agent (sleeping drug) sevoflurane 8% with oxygen by pediatric anesthesia circle system. The sevoflurane concentration will be adjusted to 3% to 4% once the adequate depth of anesthesia achieved, as evident by jaw relaxation and tolerance of an oral airway.
* The LMA will be placed after the insertion of intravenous line.
* The LMA size will be determined as per manufacturer's recommendation; which suggest 1.5 LMA size for 5-10 kg, size 2 for 10-20 kg and size 2.5 for 20-30 kg.
* The anesthesia will be maintained with isoflurane in 60% nitrous oxide and 40% oxygen. Patients will be ventilated by spontaneous mode by 'Mapleson F anesthesia circuit' and for above 25 Kg patient, the circle system will be used.
* Caudal analgesia was standardised in both study groups.
* Prior to LMA removal in group-I, isoflurane MAC awake (MAC less than 0.5) will be achieved in expiratory gases with 60% nitrous oxide and 40% oxygen. Propofol 1 mg/Kg will be combined with Isoflurane MAC awake and LMA will be removed after 20 seconds of propofol administration in group-I.

The group-II LMA will removed at end expiratory isoflurane MAC of 1.2% with 60% nitrous oxide and 40% oxygen. In both groups; LMA will be removed with inflated cuff, throat was suctioned and patients were turned into lateral recovery position.

Isoflurane and nitrous oxide were turned off and 100% oxygen supplemented till the patient had regained consciousness. All participants were transported to Post Anesthesia Care Unit (PACU) once ensured airway patency and peripheral oxygen saturation (Sp02) greater than 93% on room air. Children were allowed to wake up effortlessly in PACU at oxygen 5 litters/minutes via Hudson mask.

\- The following study variables will be recorded;

1. Emergence time ( patient awakening time),
2. Duration of recovery room stay (Post anesthesia care unit),
3. Smooth Laryngeal Mask Airway removal will be assessed by

* Cough,
* Hypersalivation,
* 02 desaturation \< 90%,
* Teeth clenching,
* Airway obstruction requiring jaw support,
* Laryngospasm,
* Bronchospasm,
* Retching,
* Vomiting,
4. Confounding variables will be assessed like;

* Patients demographics,
* Duration of surgery,
* Duration of anesthesia,
* Type of surgery,
* Mode of analgesia
* Number of Laryngeal Mask Airway insertion attempts:

Conditions

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Complication of Anesthesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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propofol with Isoflurane

Propofol with Isoflurane, Group-I is the intervention arm with combination of two drugs such as low dose propofol and Isoflurane MAC awake.

Group Type EXPERIMENTAL

comparison of group-I (low dose propofol with isoflurane)

Intervention Type DRUG

Prior to LMA removal in group-I, isoflurane MAC awake (MAC less than 0.5) will be achieved in expiratory gases with 60% nitrous oxide and 40% oxygen. Propofol 1 mg/Kg will be combined with Isoflurane MAC awake and LMA will be removed after 20 seconds of propofol administration in group-I. The group-II LMA will be removed at end expiratory isoflurane MAC of 1.2% with 60% nitrous oxide and 40% oxygen

alone isoflurane

The group-II is the control arm of study by using the only Isoflurane 1.2 MAC

Group Type ACTIVE_COMPARATOR

comparison of group-I (low dose propofol with isoflurane)

Intervention Type DRUG

Prior to LMA removal in group-I, isoflurane MAC awake (MAC less than 0.5) will be achieved in expiratory gases with 60% nitrous oxide and 40% oxygen. Propofol 1 mg/Kg will be combined with Isoflurane MAC awake and LMA will be removed after 20 seconds of propofol administration in group-I. The group-II LMA will be removed at end expiratory isoflurane MAC of 1.2% with 60% nitrous oxide and 40% oxygen

Interventions

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comparison of group-I (low dose propofol with isoflurane)

Prior to LMA removal in group-I, isoflurane MAC awake (MAC less than 0.5) will be achieved in expiratory gases with 60% nitrous oxide and 40% oxygen. Propofol 1 mg/Kg will be combined with Isoflurane MAC awake and LMA will be removed after 20 seconds of propofol administration in group-I. The group-II LMA will be removed at end expiratory isoflurane MAC of 1.2% with 60% nitrous oxide and 40% oxygen

Intervention Type DRUG

Other Intervention Names

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group-II (alone isoflurane MAC 1.2%)

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiologist class-I \& II patients.
* mallampatis class I \& II.
* Age from 2 years to 10 years.
* Elective surgical patients for below umbilical general surgical procedures.

Exclusion Criteria

* Congenital disorders
* Airway or facial abnormalities
* Reactive airway disease/asthma
* Anticipated difficult airway
* History of Upper respiratory tract infection in last 3 weeks
* History of gastroesophageal reflux disorders
* Known allergic to isoflurane and propofol
Minimum Eligible Age

2 Years

Maximum Eligible Age

10 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Aga Khan University

OTHER

Sponsor Role lead

Responsible Party

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Dileep Kumar

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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dileep kumar, FCPS

Role: PRINCIPAL_INVESTIGATOR

Aga Khan University Hospital Karachi

Locations

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Operating room at Aga Khan University Hospital

Karachi, Sindh, Pakistan

Site Status

Countries

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Pakistan

References

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Frediani M, Blanchini G, Capanna M, Casini L, Costa M, Uggeri S, Meini M, Pacini P. [The laryngeal mask in pediatric anesthesia]. Minerva Anestesiol. 1996 Mar;62(3):65-71. Italian.

Reference Type BACKGROUND
PMID: 8767151 (View on PubMed)

Brain AI. The laryngeal mask--a new concept in airway management. Br J Anaesth. 1983 Aug;55(8):801-5. doi: 10.1093/bja/55.8.801.

Reference Type BACKGROUND
PMID: 6349667 (View on PubMed)

Samarkandi AH. Awake removal of the laryngeal mask airway is safe in paediatric patients. Can J Anaesth. 1998 Feb;45(2):150-2. doi: 10.1007/BF03013254.

Reference Type BACKGROUND
PMID: 9512850 (View on PubMed)

Splinter WM, Reid CW. Removal of the laryngeal mask airway in children: deep anesthesia versus awake. J Clin Anesth. 1997 Feb;9(1):4-7. doi: 10.1016/S0952-8180(96)00217-6.

Reference Type BACKGROUND
PMID: 9051538 (View on PubMed)

Nunez J, Hughes J, Wareham K, Asai T. Timing of removal of the laryngeal mask airway. Anaesthesia. 1998 Feb;53(2):126-30. doi: 10.1046/j.1365-2044.1998.00298.x.

Reference Type BACKGROUND
PMID: 9534633 (View on PubMed)

Pappas AL, Sukhani R, Lurie J, Pawlowski J, Sawicki K, Corsino A. Severity of airway hyperreactivity associated with laryngeal mask airway removal: correlation with volatile anesthetic choice and depth of anesthesia. J Clin Anesth. 2001 Nov;13(7):498-503. doi: 10.1016/s0952-8180(01)00318-x.

Reference Type BACKGROUND
PMID: 11704447 (View on PubMed)

Baird MB, Mayor AH, Goodwin AP. Removal of the laryngeal mask airway: factors affecting the incidence of post-operative adverse respiratory events in 300 patients. Eur J Anaesthesiol. 1999 Apr;16(4):251-6. doi: 10.1046/j.1365-2346.1999.00476.x.

Reference Type BACKGROUND
PMID: 10234495 (View on PubMed)

Kitching AJ, Walpole AR, Blogg CE. Removal of the laryngeal mask airway in children: anaesthetized compared with awake. Br J Anaesth. 1996 Jun;76(6):874-6. doi: 10.1093/bja/76.6.874.

Reference Type BACKGROUND
PMID: 8679367 (View on PubMed)

Afshan G, Chohan U, Qamar-Ul-Hoda M, Kamal RS. Is there a role of a small dose of propofol in the treatment of laryngeal spasm? Paediatr Anaesth. 2002 Sep;12(7):625-8. doi: 10.1046/j.1460-9592.2002.00937.x.

Reference Type BACKGROUND
PMID: 12358660 (View on PubMed)

Other Identifiers

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1995-Ane-ERC-11

Identifier Type: -

Identifier Source: org_study_id

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