Endotracheal Intubation Without Muscle Relaxants

NCT ID: NCT03112564

Last Updated: 2017-04-13

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

91 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-03-01

Study Completion Date

2014-12-15

Brief Summary

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Prospective study conducted between March 2013 and November 2014 at Hospital Universitario Puerta de Hierro-Majadahonda, in Madrid, Spain to identify complications and evaluate the efficacy of pure inhalational anesthesia induction to achieve endotracheal intubation without the use of muscle relaxant and analgesic drugs.

Detailed Description

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This is a prospective study conducted between March 2013 and November 2014 at Hospital Universitario Puerta de Hierro-Majadahonda, in Madrid, Spain, with the previous approval by the institutional clinical research ethics committee. A total of 91 subjects who underwent general, gastrointestinal, orthopedic, urology and neurological surgery were randomly selected and provided written informed consent before any study-related procedures were performed.

The aim of this study was to identify complications and evaluate the efficacy of pure inhalational anesthesia induction to achieve endotracheal intubation without the use of muscle relaxant and analgesic drugs.

Conditions

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Muscle Relaxation Intubation Complication

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Sevoflurane 8% + Intravenous fentanyl

Avoidance of rocuronium/cisatracurium

Group Type OTHER

Avoidance of rocuronium/cisatracurium

Intervention Type OTHER

Anesthesia induction was performed at tidal volume, avoiding the use of analgesics and/or muscle relaxants with FGF of 6 L/min. Induction time was shortened as the FGF was increased. Once 5% sevoflurane end-tidal volume was reached, ventilation with facial mask was maintained for three more minutes. The time lapsed until the loss of blink reflex was achieved and orotracheal tube (OTT) was placed, difficulties in OTT placement, sevoflurane end-tidal volume after OTT placement, complications related to OTT insertion (movement, coughing, rigidity, apnea), mean arterial pressure (MAP) variations were measured. No muscle relaxants were given during surgery.

Sevoflurane 8% + Intravenous fentanyl

Intervention Type DRUG

Sevoflurane 8% + Intravenous fentanyl was the regimen used for induction and maintenance of anesthesia

Interventions

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Avoidance of rocuronium/cisatracurium

Anesthesia induction was performed at tidal volume, avoiding the use of analgesics and/or muscle relaxants with FGF of 6 L/min. Induction time was shortened as the FGF was increased. Once 5% sevoflurane end-tidal volume was reached, ventilation with facial mask was maintained for three more minutes. The time lapsed until the loss of blink reflex was achieved and orotracheal tube (OTT) was placed, difficulties in OTT placement, sevoflurane end-tidal volume after OTT placement, complications related to OTT insertion (movement, coughing, rigidity, apnea), mean arterial pressure (MAP) variations were measured. No muscle relaxants were given during surgery.

Intervention Type OTHER

Sevoflurane 8% + Intravenous fentanyl

Sevoflurane 8% + Intravenous fentanyl was the regimen used for induction and maintenance of anesthesia

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Male or Female patients
* Age ≥ 18 years
* ASA ≤ 3
* Able to provide informed consent

Exclusion Criteria

* Subjects with left ventricle ejection fraction (LEVF) ≤ 35%
* History of ischemic heart disease in the last year
* History of malignant hyperthermia
* Presence of thoracic drain tubes
* Increased intracranial pressure (ICP) or brain tumors, undergoing neurophysiological monitoring
* Hemodynamic instability or likely to become unstable during induction of anesthesia
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Puerta de Hierro University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Antonio Romero Berrocal

Anesthesiology and Critical Care

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Antonio Romero Berrocal, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario Puerta de Hierro, Madrid, Spain

Locations

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Hospital Universitario Puerta de Hierro

Majadahonda, Madrid, Spain

Site Status

Countries

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Spain

References

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Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg. 1992 Nov;75(5):788-93. doi: 10.1213/00000539-199211000-00024.

Reference Type BACKGROUND
PMID: 1416135 (View on PubMed)

Savarese JJ, Caldwell JE, Lien CA, Miller RD. Pharmacology of muscle relaxants and their antagonists. Anesthesia. 2000;5:412-90.

Reference Type BACKGROUND

Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg. 1998 Jan;86(1):45-9. doi: 10.1097/00000539-199801000-00009.

Reference Type BACKGROUND
PMID: 9428849 (View on PubMed)

Joo HS, Perks WJ. Sevoflurane versus propofol for anesthetic induction: a meta-analysis. Anesth Analg. 2000 Jul;91(1):213-9. doi: 10.1097/00000539-200007000-00040.

Reference Type BACKGROUND
PMID: 10866915 (View on PubMed)

Trepanier CA, Brousseau C, Lacerte L. Myalgia in outpatient surgery: comparison of atracurium and succinylcholine. Can J Anaesth. 1988 May;35(3 ( Pt 1)):255-8. doi: 10.1007/BF03010619.

Reference Type BACKGROUND
PMID: 3289770 (View on PubMed)

Kirkbride DA, Parker JL, Williams GD, Buggy DJ. Induction of anesthesia in the elderly ambulatory patient: a double-blinded comparison of propofol and sevoflurane. Anesth Analg. 2001 Nov;93(5):1185-7, table of contents. doi: 10.1097/00000539-200111000-00026.

Reference Type BACKGROUND
PMID: 11682393 (View on PubMed)

Thwaites A, Edmends S, Smith I. Inhalation induction with sevoflurane: a double-blind comparison with propofol. Br J Anaesth. 1997 Apr;78(4):356-61. doi: 10.1093/bja/78.4.356.

Reference Type BACKGROUND
PMID: 9135350 (View on PubMed)

Knaggs CL, Drummond GB. Randomized comparison of three methods of induction of anaesthesia with sevoflurane. Br J Anaesth. 2005 Aug;95(2):178-82. doi: 10.1093/bja/aei149. Epub 2005 Apr 29.

Reference Type BACKGROUND
PMID: 15863438 (View on PubMed)

Topuz D, Postaci A, Sacan O, Yildiz N, Dikmen B. A comparison of sevoflurane induction versus propofol induction for laryngeal mask airway insertion in elderly patients. Saudi Med J. 2010 Oct;31(10):1124-9.

Reference Type BACKGROUND
PMID: 20953528 (View on PubMed)

Walpole R, Logan M. Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly. Br J Anaesth. 1999 Jan;82(1):20-4. doi: 10.1093/bja/82.1.20.

Reference Type BACKGROUND
PMID: 10325830 (View on PubMed)

Vidal MA, Calderon E, Martinez E, Pernia A, Torres LM. [Comparison of 2 techniques for inhaled anesthetic induction with sevoflurane in coronary artery revascularization]. Rev Esp Anestesiol Reanim. 2006 Dec;53(10):639-42. Spanish.

Reference Type BACKGROUND
PMID: 17302078 (View on PubMed)

Siddik-Sayyid SM, Aouad MT, Taha SK, Daaboul DG, Deeb PG, Massouh FM, Muallem MA, Baraka AS. A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults. Anesth Analg. 2005 Apr;100(4):1204-1209. doi: 10.1213/01.ANE.0000148166.29749.3B.

Reference Type BACKGROUND
PMID: 15781547 (View on PubMed)

Bel Marcoval I, Gambus Cerrillo P. [Risk assessment, prophylaxis and treatment for postoperative nausea and vomiting]. Rev Esp Anestesiol Reanim. 2006 May;53(5):301-11. Spanish.

Reference Type BACKGROUND
PMID: 16827070 (View on PubMed)

Philip BK, Lombard LL, Roaf ER, Drager LR, Calalang I, Philip JH. Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol for adult ambulatory anesthesia. Anesth Analg. 1999 Sep;89(3):623-7. doi: 10.1097/00000539-199909000-00014.

Reference Type BACKGROUND
PMID: 10475291 (View on PubMed)

Other Identifiers

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HUPH:PI:13/15

Identifier Type: -

Identifier Source: org_study_id

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