Effect of Dexmedetomidine After Thyroidectomy

NCT ID: NCT02412150

Last Updated: 2020-11-27

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

139 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-04-30

Study Completion Date

2020-11-25

Brief Summary

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The purpose of the present study was to compare the effect of dexmedetomidine which is administered during emergence in adult patients undergoing elective thyroidectomy on smooth emergence form general anesthesia (reducing agitation or coughing, signs of hypertension or tachycardia, or etc.) and postoperative outcome (postoperative bleeding and hospital staying).

Detailed Description

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Smooth emergence from general anaesthesia after surgery is important to prevent potentially dangerous effects such as hypertension, tachycardia, myocardial ischaemia, arrhythmias and increased intracranial and intra-abdominal pressure. After thyroidectomy, activities during emergence such as agitation or coughing, signs of hypertension or tachycardia, or etc. may lead to postoperative bleeding, resulting in acute airway obstruction or reoperation.

The purpose of the present study was to compare the effect of dexmedetomidine which is administered during emergence in adult patients undergoing elective thyroidectomy on smooth emergence form general anesthesia and postoperative outcome.

Conditions

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Thyroid Tumor

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Dexmedetomidine (Group D)

After induction of anesthesia, anesthesia is maintained with desflurane and remifentanil during thyroidectomy.

Fifteen minutes before the end of surgery, infusion of remifentanil for surgery is discontinued.

Then, dexmedetomidine has started infusion for 15 min (rate of 0.6 ug/kg/hr). Vital signs and complications of testing drugs are measured before and after infusion of testing drugs.

Five minutes before the end of surgery, anesthetic gas (desflurane) is discontinued.

After patient has awake, extubation has done. Extubation time and Recovery time,Cough reflex,Ramsay Sedation Scale, Visual analogue scale, and surgical outcomes such as postoperative bleeding, time to remove drainage and duration of hospital staying, postoperative complications are measured until POD#3.

Group Type EXPERIMENTAL

Desflurane

Intervention Type DRUG

Anesthesia is maintained with desflurane

Remifentanil

Intervention Type DRUG

Remifentanil is infused for the maintenance of anesthesia during surgery and discontinued 15 min before end of surgery

Thyroidectomy

Intervention Type PROCEDURE

The aim of this study is evaluation of effect of dexmedetomidine on emergence response and postoperative outcome after thyroidectomy

Vital signs

Intervention Type OTHER

Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate are measured before infusion of testing drugs, after infusion of them (5 min, 10 min, and 15 min), during extubation (0 min and 5 min after extubation), and at recovery room.

And the complications such as hypotension, hypertension, bradycardia, tachycardia, and desaturation after infusion of testing drugs are observed.

Cough reflex

Intervention Type BEHAVIORAL

During recovery from anesthesia at operation room, cough reflex is measured and rated. \[Grade 0, no cough; Grade 1, single cough with mild severity; Grade 2, cough persistence less than 5 s with moderate severity; Grade 3, severe, persistent cough for more than 5 s (bucking)\]

Ramsay Sedation Scale

Intervention Type BEHAVIORAL

When the patient has fully awaken and transferred to the recovery room, Ramsay Sedation Scale is measured.

1. Awake Patient anxious and agitated or restless or both!
2. Patient cooperative, oriented and tranquil!
3. Patient responds to commands only!
4. Asleep A brisk response to a light glabellar tap or loud auditory stimulus!
5. A sluggish response to a light glabellar tap or loud auditory stimulus!
6. No response to a light glabellar tap or loud auditory stimulus

Extubation time and Recovery time

Intervention Type OTHER

The time from discontinuing anesthetic gas to endotracheal extubation is measured.

And the time from the discontinuing of anesthetic gas to transferring to the recovery room is also measured.

Visual analogue scale

Intervention Type BEHAVIORAL

The severity of pain after surgery is measured by VAS (at recovery room, POD 1, POD 2, and POD 3)

Postoperative bleeding

Intervention Type OTHER

The amount of postoperative bleeding which is collected in the barovac is measured.

Postoperative complications

Intervention Type OTHER

Postoperative complications after thyroidectomy such as hoarseness and hematoma, and reoperation due to such complication is observed.

Time to remove drainage and duration of hospital staying

Intervention Type OTHER

The time from the end of surgery to remove drainage is measured. And the duration of hospital staying is measured.

Dexmedetomidine

Intervention Type DRUG

Dexmedetomidine has started infusion for 15 min (rate of 0.6 ug/kg/hr) before end of surgery as experimental intervention

Normal Saline (Group N)

After induction of anesthesia, anesthesia is maintained with desflurane and remifentanil during thyroidectomy.

Fifteen minutes before the end of surgery, infusion of remifentanil for surgery is discontinued. Then, normal saline has started infusion for 15 min (same rate as Group D). Vital signs and complications of testing drugs are measured before and after infusion of testing drugs.

Five minutes before the end of surgery, anesthetic gas (desflurane) is discontinued.

After patient has awake, extubation has done. Extubation time and Recovery time,Cough reflex,Ramsay Sedation Scale, Visual analogue scale, and surgical outcomes such as postoperative bleeding, time to remove drainage duration of hospital staying, postoperative complications are measured until POD#3.

Group Type PLACEBO_COMPARATOR

Desflurane

Intervention Type DRUG

Anesthesia is maintained with desflurane

Remifentanil

Intervention Type DRUG

Remifentanil is infused for the maintenance of anesthesia during surgery and discontinued 15 min before end of surgery

Thyroidectomy

Intervention Type PROCEDURE

The aim of this study is evaluation of effect of dexmedetomidine on emergence response and postoperative outcome after thyroidectomy

Vital signs

Intervention Type OTHER

Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate are measured before infusion of testing drugs, after infusion of them (5 min, 10 min, and 15 min), during extubation (0 min and 5 min after extubation), and at recovery room.

And the complications such as hypotension, hypertension, bradycardia, tachycardia, and desaturation after infusion of testing drugs are observed.

Cough reflex

Intervention Type BEHAVIORAL

During recovery from anesthesia at operation room, cough reflex is measured and rated. \[Grade 0, no cough; Grade 1, single cough with mild severity; Grade 2, cough persistence less than 5 s with moderate severity; Grade 3, severe, persistent cough for more than 5 s (bucking)\]

Ramsay Sedation Scale

Intervention Type BEHAVIORAL

When the patient has fully awaken and transferred to the recovery room, Ramsay Sedation Scale is measured.

1. Awake Patient anxious and agitated or restless or both!
2. Patient cooperative, oriented and tranquil!
3. Patient responds to commands only!
4. Asleep A brisk response to a light glabellar tap or loud auditory stimulus!
5. A sluggish response to a light glabellar tap or loud auditory stimulus!
6. No response to a light glabellar tap or loud auditory stimulus

Extubation time and Recovery time

Intervention Type OTHER

The time from discontinuing anesthetic gas to endotracheal extubation is measured.

And the time from the discontinuing of anesthetic gas to transferring to the recovery room is also measured.

Visual analogue scale

Intervention Type BEHAVIORAL

The severity of pain after surgery is measured by VAS (at recovery room, POD 1, POD 2, and POD 3)

Postoperative bleeding

Intervention Type OTHER

The amount of postoperative bleeding which is collected in the barovac is measured.

Postoperative complications

Intervention Type OTHER

Postoperative complications after thyroidectomy such as hoarseness and hematoma, and reoperation due to such complication is observed.

Time to remove drainage and duration of hospital staying

Intervention Type OTHER

The time from the end of surgery to remove drainage is measured. And the duration of hospital staying is measured.

Normal saline

Intervention Type DRUG

Normal saline has started infusion for 15 min (as same rate of dexmedetomidine) before end of surgery as control intervention

Interventions

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Desflurane

Anesthesia is maintained with desflurane

Intervention Type DRUG

Remifentanil

Remifentanil is infused for the maintenance of anesthesia during surgery and discontinued 15 min before end of surgery

Intervention Type DRUG

Thyroidectomy

The aim of this study is evaluation of effect of dexmedetomidine on emergence response and postoperative outcome after thyroidectomy

Intervention Type PROCEDURE

Vital signs

Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate are measured before infusion of testing drugs, after infusion of them (5 min, 10 min, and 15 min), during extubation (0 min and 5 min after extubation), and at recovery room.

And the complications such as hypotension, hypertension, bradycardia, tachycardia, and desaturation after infusion of testing drugs are observed.

Intervention Type OTHER

Cough reflex

During recovery from anesthesia at operation room, cough reflex is measured and rated. \[Grade 0, no cough; Grade 1, single cough with mild severity; Grade 2, cough persistence less than 5 s with moderate severity; Grade 3, severe, persistent cough for more than 5 s (bucking)\]

Intervention Type BEHAVIORAL

Ramsay Sedation Scale

When the patient has fully awaken and transferred to the recovery room, Ramsay Sedation Scale is measured.

1. Awake Patient anxious and agitated or restless or both!
2. Patient cooperative, oriented and tranquil!
3. Patient responds to commands only!
4. Asleep A brisk response to a light glabellar tap or loud auditory stimulus!
5. A sluggish response to a light glabellar tap or loud auditory stimulus!
6. No response to a light glabellar tap or loud auditory stimulus

Intervention Type BEHAVIORAL

Extubation time and Recovery time

The time from discontinuing anesthetic gas to endotracheal extubation is measured.

And the time from the discontinuing of anesthetic gas to transferring to the recovery room is also measured.

Intervention Type OTHER

Visual analogue scale

The severity of pain after surgery is measured by VAS (at recovery room, POD 1, POD 2, and POD 3)

Intervention Type BEHAVIORAL

Postoperative bleeding

The amount of postoperative bleeding which is collected in the barovac is measured.

Intervention Type OTHER

Postoperative complications

Postoperative complications after thyroidectomy such as hoarseness and hematoma, and reoperation due to such complication is observed.

Intervention Type OTHER

Time to remove drainage and duration of hospital staying

The time from the end of surgery to remove drainage is measured. And the duration of hospital staying is measured.

Intervention Type OTHER

Dexmedetomidine

Dexmedetomidine has started infusion for 15 min (rate of 0.6 ug/kg/hr) before end of surgery as experimental intervention

Intervention Type DRUG

Normal saline

Normal saline has started infusion for 15 min (as same rate of dexmedetomidine) before end of surgery as control intervention

Intervention Type DRUG

Other Intervention Names

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Anesthetic gas Opioid Surgery Hemodynamics RSS VAS Precedex NS

Eligibility Criteria

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Inclusion Criteria

* Female patient,
* Aged 20-60 yr,
* ASA physical status 1-2,
* Patients undergoing elective thyroidectomy under general anesthesia

Exclusion Criteria

* Sighs of difficult airway,
* History of respiratory disease or chronic cough,
* Cardiovascular disease,
* Pregnant or breast-feeding woman
Minimum Eligible Age

20 Years

Maximum Eligible Age

60 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Chosun University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ki Tae Jung

Assist Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ki Tae Jung, M.D.

Role: STUDY_CHAIR

Chosun University Hospital

Locations

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Chosun University Hospital

Gwangju, Donggu, South Korea

Site Status

Countries

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South Korea

References

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Patel A, Davidson M, Tran MC, Quraishi H, Schoenberg C, Sant M, Lin A, Sun X. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Analg. 2010 Oct;111(4):1004-10. doi: 10.1213/ANE.0b013e3181ee82fa. Epub 2010 Aug 12.

Reference Type BACKGROUND
PMID: 20705788 (View on PubMed)

Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg. 2000 Aug;24(8):971-5. doi: 10.1007/s002680010160.

Reference Type BACKGROUND
PMID: 10865043 (View on PubMed)

Lee B, Lee JR, Na S. Targeting smooth emergence: the effect site concentration of remifentanil for preventing cough during emergence during propofol-remifentanil anaesthesia for thyroid surgery. Br J Anaesth. 2009 Jun;102(6):775-8. doi: 10.1093/bja/aep090. Epub 2009 May 2.

Reference Type RESULT
PMID: 19411668 (View on PubMed)

Kim SH, Kim YS, Kim S, Jung KT. Dexmedetomidine decreased the post-thyroidectomy bleeding by reducing cough and emergence agitation - a randomized, double-blind, controlled study. BMC Anesthesiol. 2021 Apr 12;21(1):113. doi: 10.1186/s12871-021-01325-6.

Reference Type DERIVED
PMID: 33845761 (View on PubMed)

Other Identifiers

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2014-04-004-003

Identifier Type: OTHER

Identifier Source: secondary_id

DEX_ENT

Identifier Type: -

Identifier Source: org_study_id