Automatic Remifentanil Administration Guided by ANI During Propofol Anesthesia

NCT ID: NCT03556696

Last Updated: 2022-12-16

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

52 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-06-27

Study Completion Date

2022-11-22

Brief Summary

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Prospective Randomized Monocentric Clinical Trial during propofol anesthesia. The aim of the study is to test whether the use of a medical device designed to automatically administer remifentanil during surgery based on expert rules and continuous reading of heart rate, blood pressure and the Analgesia Nociception Index results in lower overall remifentanil administration versus standard practice.

Detailed Description

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Prospective Randomized Monocentric Clinical Trial during propofol anesthesia.

* inclusion: ASA 1, 2 or 3 adult patients scheduled to undergo burn wound surgery in a Burn Center (University Hospital of Lille, France)
* arm 1 : Remifentanil will be automatically administered by an expert system guided by heart rate, blood pressure and the Analgesia Nociception Index (ANI).
* arm 2 : Remifentanil will be administered by a target controlled device using the Minto pK/pD model.
* propofol is administered throughout the procedure with a target controlled device using the pK/pD model of Schnider. The target will be guided by the BiSpectral index values.
* primary endpoint : overall normalized remifentanil administration.
* secondary endpoints : relative amount of time spent in a state of hemodynamic reactivity ; relative amount of time the ANI spends in the \[0-50\], \[50-70\] and \[70-100\] windows ; relative amount of time the BIS spends in the \[0-40\], \[40-60\] and \[60-100\] ; hemodynamic status at various times during anesthesia ; total amount of target modifications of remifentanil and propofol ; total amount of morphine administered in PACU ; total amount of ketamine administered in PACU ; incidence of nausea/vomiting in PACU ;

Conditions

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Nociceptive Pain Surgical Procedure, Unspecified

Keywords

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general anesthesia analgesia/nociception balance monitoring expert system

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Monocentric prospective randomized controlled clinical trial

* arm 1: medical device automatically administering remifentanil, guided by expert rules and continuous reading of heart rate, blood pressure and Analgesia Nociception Index (MDMS, Loos, France)
* arm 2 : standard practice : remifentanil is administered using a target controlled device using a pK/pD model of Minto
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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ANI-loop

arm 1 : remifentanil is automatically administered by a medical device using expert rules and continuous reading of heart rate, blood pressure and Analgesia Nociception Index (MDMS, Loos, France)

Group Type EXPERIMENTAL

ANI-REMI-loop

Intervention Type DEVICE

experimental medical device using expert rules and continuous reading of heart rate, blood pressure and Analgesia Nociception Index for automatic remifentanil administration

Remifentanil

Intervention Type DRUG

Remifentanil Ce target can range from 0 to 10 ng.ml-1. Remifentanil target is adapted in order to maintain Analgesia Nociception Index (MDMS, Loos, France) in the \[50-70\] range.

Propofol

Intervention Type DRUG

propofol is used for induction and maintenance of general anesthesia using Schnider pK/pD model. Propofol Ce target is adapted in order to maintain BiSpectral Index in \[40-60\] range

std_practice

arm 2: remifentanil is administered by a target control device using Minto's remifentanil pK/pD model. This is standard practice for this type of surgery at the Burn Center of the University Hospital of Lille, France.

Group Type ACTIVE_COMPARATOR

remifentanil pK/pD target administration device

Intervention Type DEVICE

standard practice, remifentanil administration using Minto's pK/pD model

Remifentanil

Intervention Type DRUG

Remifentanil Ce target can range from 0 to 10 ng.ml-1. Remifentanil target is adapted in order to maintain Analgesia Nociception Index (MDMS, Loos, France) in the \[50-70\] range.

Propofol

Intervention Type DRUG

propofol is used for induction and maintenance of general anesthesia using Schnider pK/pD model. Propofol Ce target is adapted in order to maintain BiSpectral Index in \[40-60\] range

ANI monitor

Intervention Type DEVICE

ANI (Analgesia Nociception Index) value is used in the "std\_practice" arm for guidance of the remifentanil Ce target

Interventions

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ANI-REMI-loop

experimental medical device using expert rules and continuous reading of heart rate, blood pressure and Analgesia Nociception Index for automatic remifentanil administration

Intervention Type DEVICE

remifentanil pK/pD target administration device

standard practice, remifentanil administration using Minto's pK/pD model

Intervention Type DEVICE

Remifentanil

Remifentanil Ce target can range from 0 to 10 ng.ml-1. Remifentanil target is adapted in order to maintain Analgesia Nociception Index (MDMS, Loos, France) in the \[50-70\] range.

Intervention Type DRUG

Propofol

propofol is used for induction and maintenance of general anesthesia using Schnider pK/pD model. Propofol Ce target is adapted in order to maintain BiSpectral Index in \[40-60\] range

Intervention Type DRUG

ANI monitor

ANI (Analgesia Nociception Index) value is used in the "std\_practice" arm for guidance of the remifentanil Ce target

Intervention Type DEVICE

Other Intervention Names

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PhysioDoloris (MDMS, Loos, France)

Eligibility Criteria

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Inclusion Criteria

* ASA 1, 2 or 3 adult patients scheduled to undergo burn wound surgery at the Burn Center of the University Hospital of Lille

Exclusion Criteria

* BMI outside \[17 - 35 kg/m2\]
* pregnancy or breast feeding women
* non sinus cardiac rhythm
* documented dysautonomia
* complicated diabetes mellitus
* known allergy to a drug used in the clinical trial
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Lille

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mathieu JEANNE, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Lille

Locations

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Hôpital Roger Salengro, CHU

Lille, , France

Site Status

Countries

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France

Other Identifiers

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2017-A00858-45

Identifier Type: OTHER

Identifier Source: secondary_id

2016_48

Identifier Type: -

Identifier Source: org_study_id