Dexmedetomidine and Desflurane Consumption

NCT ID: NCT02652312

Last Updated: 2016-11-10

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

2016-02-29

Study Completion Date

2016-10-31

Brief Summary

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The aim of this study is to calculate desflurane consumption when combined with intraoperative dexmedetomidine infusion guided by bispectral index (BIS)

Detailed Description

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Forty patients will be randomly allocated into two equal groups as Group 'D' (Dexmedetomidine group) and Group 'P' (Placebo group) using computer generated random numbers. After arrival in the operating room, ondansetron 0.15 mg/kg intravenous (IV) will be given as a pre-medication. Ringer's acetate solution (500 ml) will be infused as a preload then at a rate of 6-8 ml/kg/h during surgery for supplying maintenance and deficit. Monitoring consisted of continuous electrocardiogram (EKG), non-invasive blood pressure (NIBP), pulse oximetry (SpO2), CO2 expired fraction (ETCO2), desflurane inspired fraction (FIdes), and desflurane expired fraction (ETdes) (Infinity Kappa, Dräger, Lübeck, Germany) will be attached to the patient. BIS module (InfinityR BISxTM SmartPodR, smoothing rate: 15 or 30 seconds, software revision: VF5) will also be attached for detection of consciousness level.

All patients will be preoxygenated with 100% oxygen for 3 minutes. The patients in group D will receive dexmedetomidine (2 ml diluted in 18 ml of saline) IV in a dose of 1 mcg/kg over10 minutes through infusion pump prior to induction. Group P patients will receive similar volume of normal saline over 10 min. The study drug and placebo infusions will be prepared by an anesthesiologist who is not involved in the study and the anesthesiologist recording the details is unaware of the type of infusion patients received. Anesthesia will be induced with IV fentanyl 1.5 μg/kg and propofol in a dose of 10 mg every 5 seconds until the BIS level dropped below 60 and confirmed with loss of response to verbal commands. In both groups, Atracurium 0.5 mg/kg IV will be administered, and trachea will be intubated. Fresh gas flow oxygen in air 30-40% at a rate of 3 L/min for 10 minutes will be administered then the flow will be decreased at a rate of 1 L/min using a closed system (Fabius GS, Dräger, Lübeck, Germany) and ventilation will be adjusted to maintain end-tidal carbon dioxide at 30-35 mmHg. Patients in study groups will receive the volatile agent at a concentration of 1 MAC (Minimum Alveolar Concentration). The MAC of desflurane is defined as an expired fraction of 6.0 vol%. Then the dial-up desflurane percentage will be adjusted to establish a BIS value between 40- 50. A maintenance dose of Dexmedetomidine infusion at 0.5 mcg/kg/hour made to 20 mL with normal saline will be administered in group D patients and a similar volume of normal saline will be administered in Group P, till the end of surgery. Top up doses of Atracurium will be given as needed. When heart rate and blood pressure exceeds 20% of baseline in spite of adequate level of anesthesia guided by BIS, boluses of 0.5 μg/kg will be given. While decrease in heart rate and blood pressure more than 20% of baseline, will be treated by ephedrine 5 mg.

In both groups, dexmedetomidine or saline will be stopped approximately 15-20 minutes before completion of surgery, diclofenac sodium 1 mg/kg will be given IM at the time of skin closure. Desflurane will be discontinued after skin closure in both groups. Reversal of neuromuscular blockade will be achieved with neostigmine 0.05 mg/kg and atropine 0.02 mg/kg. Tracheal extubation will be done when respiration is satisfactory and adequate muscle tone is achieved

Conditions

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Anesthesia

Keywords

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Dexmedetomidine Desflurane Bispectral Index BIS

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Group 'D'

Dexmedetomidine group Patients received dexmedetomidine (2 ml diluted in 18 ml of saline) IV in a dose of 1 mcg/kg over 10 minutes. A maintenance dose of Dexmedetomidine infusion at 0.5 mcg/kg/hour was infused.

Ondansetron: 0.15 mg/kg intravenous preoperative. Fentanyl: 1.5 μg/kg intraoperative Propofol: 10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia.

Atracurium: 0.5 mg/kg IV. Desflurane: 1 MAC concentration. Diclofenac sodium: 1 mg/kg for postoperative analgesia.

Group Type ACTIVE_COMPARATOR

Dexmedetomidine

Intervention Type DRUG

A maintenance dose of Dexmedetomidine infusion at 0.5 mcg/kg/hour made to 20 mL with normal saline will be administered

Ondansetron

Intervention Type PROCEDURE

0.15 mg/kg intravenous (IV) will be given as a pre-medication

fentanyl

Intervention Type PROCEDURE

1.5 μg/kg intraoperative

propofol

Intervention Type PROCEDURE

10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia

Atracurium

Intervention Type PROCEDURE

0.5 mg/kg IV for endotracheal intubation

diclofenac sodium

Intervention Type PROCEDURE

1 mg/kg for postoperative analgesia

desflurane

Intervention Type PROCEDURE

1 MAC concentration (expired fraction of 6.0 vol%) for maintenance of anesthesia

Group 'P'

Placebo group Patients received similar volume of normal saline as the bolus and maintenance infusion as group D.

Ondansetron: 0.15 mg/kg intravenous preoperative. Fentanyl: 1.5 μg/kg intraoperative Propofol: 10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia.

Atracurium: 0.5 mg/kg IV. Desflurane: 1 MAC concentration. Diclofenac sodium: 1 mg/kg for postoperative analgesia.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

A maintenance dose of 20 mL with normal saline will be administered at a rate similar to that of dexmedetomidine

Ondansetron

Intervention Type PROCEDURE

0.15 mg/kg intravenous (IV) will be given as a pre-medication

fentanyl

Intervention Type PROCEDURE

1.5 μg/kg intraoperative

propofol

Intervention Type PROCEDURE

10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia

Atracurium

Intervention Type PROCEDURE

0.5 mg/kg IV for endotracheal intubation

diclofenac sodium

Intervention Type PROCEDURE

1 mg/kg for postoperative analgesia

desflurane

Intervention Type PROCEDURE

1 MAC concentration (expired fraction of 6.0 vol%) for maintenance of anesthesia

Interventions

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Dexmedetomidine

A maintenance dose of Dexmedetomidine infusion at 0.5 mcg/kg/hour made to 20 mL with normal saline will be administered

Intervention Type DRUG

Placebo

A maintenance dose of 20 mL with normal saline will be administered at a rate similar to that of dexmedetomidine

Intervention Type DRUG

Ondansetron

0.15 mg/kg intravenous (IV) will be given as a pre-medication

Intervention Type PROCEDURE

fentanyl

1.5 μg/kg intraoperative

Intervention Type PROCEDURE

propofol

10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia

Intervention Type PROCEDURE

Atracurium

0.5 mg/kg IV for endotracheal intubation

Intervention Type PROCEDURE

diclofenac sodium

1 mg/kg for postoperative analgesia

Intervention Type PROCEDURE

desflurane

1 MAC concentration (expired fraction of 6.0 vol%) for maintenance of anesthesia

Intervention Type PROCEDURE

Other Intervention Names

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Precedex Dexdor placebo effect Zofran Sublimaze,Actiq, Durogesic, Duragesic Diprivan Atracurium besilate Voltaren Suprane

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiologists (ASA) status of I and II
* undergoing elective laparoscopic cholecystectomy

Exclusion Criteria

* history of psychiatric/neurological illness
* cardiovascular disease
* morbid obese patients
* pregnant and nursing women
* known allergic reaction to any of the study medication
* recent use of sedatives or analgesics
Minimum Eligible Age

15 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Theodor Bilharz Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Yasser Mostafa Samhan

Professor of Anesthesia

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Abla El Hadidy, PhD

Role: STUDY_DIRECTOR

Theodor Bilharz Research Institute

Locations

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Theodor Bilharz Research Institute

Giza, , Egypt

Site Status

Countries

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Egypt

References

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Harsoor SS, Rani DD, Lathashree S, Nethra SS, Sudheesh K. Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia. J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):25-30. doi: 10.4103/0970-9185.125693.

Reference Type BACKGROUND
PMID: 24574589 (View on PubMed)

Kamibayashi T, Maze M. Clinical uses of alpha2 -adrenergic agonists. Anesthesiology. 2000 Nov;93(5):1345-9. doi: 10.1097/00000542-200011000-00030. No abstract available.

Reference Type BACKGROUND
PMID: 11046225 (View on PubMed)

Nishibe S, Imanishi H, Mieda T, Tsujita M. The effects of dexmedetomidine administration on the pulmonary artery pressure and the transpulmonary pressure gradient after the bidirectional superior cavopulmonary shunt. Pediatr Cardiol. 2015 Jan;36(1):151-7. doi: 10.1007/s00246-014-0979-2. Epub 2014 Aug 12.

Reference Type BACKGROUND
PMID: 25113519 (View on PubMed)

Other Identifiers

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Anesthesia 110T

Identifier Type: -

Identifier Source: org_study_id