Is Anesthetic Loss of Consciousness a Top Down or Bottom up Phenomenon. What Does the Neurologic Examination Say?.

NCT ID: NCT03140982

Last Updated: 2017-05-31

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

16 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-06-01

Study Completion Date

2016-12-15

Brief Summary

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Using very slow or fast propofol intravenous injection, monitored using standard American Society of Anesthesiology (ASA) standard and SEDLine EEG (Med Tech), the patient was evaluate by a neurologist every 30 sec using the FOUR coma scale.

Detailed Description

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Clinical experimental randomized study, approved by the Ethic Committee, with informed consent, included ASA I- II adults, without neurological illness and normal physical exam.

The patient randomized in two groups, rapid induction (GR) with propofol in target controlled infusion (TCI) effect site mode using the phamacokinetic (PK) model from Marsh ke0 1,21 min-1 using a calculated target of 5.4 ug/ml (loss of counsciousness EC95) and slow induction (GL) 10 mg/kg/h with calculated effect site concentrations (CeCALC) same PK model.

The same neurologist, blind to the correspondent group, evaluated all the patients every 30 sec using the coma FOUR scale until loss of counsciousness (LOC), defined as a FOUR (E0 no eyes opening response and /or M0 no motor response). At LOC the existance of brainstem reflex was evaluated (B no pupil and corneal reflex), respiratory pattern (R apnoea), CeCALC and patient state index (PSI) SEDline™ was recorded during all the examination.

After LOC in both groups we maintain in GR the initial target (5.3 ug/ml) and the LOC CeCALC during 10 min without intervention, except respiratory support if it was required.

Frontal EEG 4 channel and spectrogram from SEDline monitor was extracted for each case and posterior analysis.

Fisher exact test was used to describe primary outcome and difference between B and R for each group. The difference in time to reach LOC LOC, Ce and PSI was analysed with T- Student.

Conditions

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Anesthesia; Functional

Keywords

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propofol pharmacology anesthesic induction drug titration

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

comparison of the neurologic behavior between two group, a fast and a slow anesthesia induction
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
after patient constent, and previos the patient arriving the OR, the care provider (designed anesthestist) using a coin decide the arm (GR or GL). The neurologist and investigator was blind to the arm.

Study Groups

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GR fast induction

propofol TCI effect site mode infusion using the PK Marsh model ke0 1,21 min-1 target 5.4 ug/ml (LOC EC95) util loss of consciousness (LOC) After LOC we maintain initial target during 10 min without intervention, except respiratory support if required.

Group Type ACTIVE_COMPARATOR

FOUR coma scale and frontal espectrograpy evaluation

Intervention Type DIAGNOSTIC_TEST

systematic evaluation using the validated FOUR coma scale during propofol administration

GL slow induction

propofol infused at 10 mg/kg/h with CeCALC PK Marsh model ke0 1,21 min-1 same PK model After LOC we maintain the CeCALC observed al LOC during 10 min without intervention, except respiratory support if it was required.

Group Type ACTIVE_COMPARATOR

FOUR coma scale and frontal espectrograpy evaluation

Intervention Type DIAGNOSTIC_TEST

systematic evaluation using the validated FOUR coma scale during propofol administration

Interventions

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FOUR coma scale and frontal espectrograpy evaluation

systematic evaluation using the validated FOUR coma scale during propofol administration

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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4 channel EEG record with SEDline monitor Non Invasive Blood presure, Saturation 02, Electrocardiogram propofol infusion in Target controlled infusion using Primea Orchestra infusion pump Fressenius Kabi

Eligibility Criteria

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Exclusion Criteria

\-
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universidad del Desarrollo

OTHER

Sponsor Role lead

Responsible Party

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Pablo O. Sepulveda

MD. Professor in Anesthesia

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Pablo Lavados, MD

Role: STUDY_CHAIR

Clinica Alemana Comité Cientifico

Locations

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Clinica Alemana de Santiago

Santiago, Santiago Metropolitan, Chile

Site Status

Countries

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Chile

References

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Brown EN, Lydic R, Schiff ND. General anesthesia, sleep, and coma. N Engl J Med. 2010 Dec 30;363(27):2638-50. doi: 10.1056/NEJMra0808281. No abstract available.

Reference Type BACKGROUND
PMID: 21190458 (View on PubMed)

Mashour GA. Top-down mechanisms of anesthetic-induced unconsciousness. Front Syst Neurosci. 2014 Jun 23;8:115. doi: 10.3389/fnsys.2014.00115. eCollection 2014.

Reference Type BACKGROUND
PMID: 25002838 (View on PubMed)

Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005 Oct;58(4):585-93. doi: 10.1002/ana.20611.

Reference Type BACKGROUND
PMID: 16178024 (View on PubMed)

Other Identifiers

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Centro Bioetica 2016-05

Identifier Type: -

Identifier Source: org_study_id