Comparison Between Propofol and Inhalational Anaesthetic Agents on Cardiovascular Outcomes Following Cardiac Surgery

NCT ID: NCT04039854

Last Updated: 2021-02-24

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-20

Study Completion Date

2022-01-31

Brief Summary

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The objective of this research proposal is to find out whether comparing the two different anaesthetic maintenance techniques (Propofol vs volatile anaesthetics) in adult patients undergoing heart surgery is practical for the anaesthetist treating the patients and whether it is feasible for the research team to recruit patients and follow them up after the operation.

Detailed Description

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All patients undergoing heart bypass surgery are given anaesthetics during the operation. There are two types of anaesthetic commonly given to patients undergoing heart bypass surgery.

Propofol is an anaesthetic that is delivered into the patient's vein. Other anaesthetics which are inhaled include Isoflurane, Sevoflurane and Desflurane and these are called volatile anaesthetics. Preliminary studies over the past ten years suggests that maintenance of general anaesthesia using only volatile anaesthetics has the potential to improve health outcomes after bypass surgery, when compared with propofol.

Volatile anaesthetics have been shown to protect the heart, the kidneys and the brain, however results of studies have been inconclusive. Currently both volatile anaesthetics and propofol are used equally in clinical practice in the UK.

Conditions

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Coronary Heart Disease Cardiovascular Diseases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Volatile anaesthetics arm

Patients randomised to receive volatile anaesthetics will receive either isoflurane, sevoflurane or desflurane during the surgical procedure.

Group Type ACTIVE_COMPARATOR

Isoflurane, Sevoflurane or Desflurane

Intervention Type DRUG

The volatile anaesthetic agent will be administered via inhalation, i.e. ventilation through alveolar membrane in lungs) during the maintenance of anaesthesia. During CPB the volatile anaesthetic agent will be administered through the oxygenator oxygen inflow of the CPB machine.

The maintenance dose of the volatile anaesthetic agent will be titrated to doses deemed necessary in order to provide sufficient depth of anaesthesia and blood pressure.

The administration of the volatile anaesthetic agent will be started after induction of anaesthesia and it will be ended at the end of surgery, before the patient is transferred to the CCU.

Propofol anaesthetics arm

Patients randomised to receive propofol will not receive any volatile anaesthetics during the surgical procedure.

Group Type ACTIVE_COMPARATOR

Propofol

Intervention Type DRUG

Patients will receive propofol only during the surgical procedure. The maintenance dose of the propofol infusion will be titrated to doses deemed necessary in order to provide sufficient depth of anaesthesia (titrated to a depth of anaesthesia with BIS 30-60) and mean arterial pressure (MAP) of 50-80mmHg by the treating anaesthetist.

Interventions

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Isoflurane, Sevoflurane or Desflurane

The volatile anaesthetic agent will be administered via inhalation, i.e. ventilation through alveolar membrane in lungs) during the maintenance of anaesthesia. During CPB the volatile anaesthetic agent will be administered through the oxygenator oxygen inflow of the CPB machine.

The maintenance dose of the volatile anaesthetic agent will be titrated to doses deemed necessary in order to provide sufficient depth of anaesthesia and blood pressure.

The administration of the volatile anaesthetic agent will be started after induction of anaesthesia and it will be ended at the end of surgery, before the patient is transferred to the CCU.

Intervention Type DRUG

Propofol

Patients will receive propofol only during the surgical procedure. The maintenance dose of the propofol infusion will be titrated to doses deemed necessary in order to provide sufficient depth of anaesthesia (titrated to a depth of anaesthesia with BIS 30-60) and mean arterial pressure (MAP) of 50-80mmHg by the treating anaesthetist.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients (male and female) aged 18 years and above
* Written informed consent to participate
* Patients undergoing Coronary Artery Bypass Graft (CABG) surgery on Cardiopulmonary bypass (CPB) with or without valve surgery
* Additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 5 or higher

Exclusion Criteria

* Pregnant or lactating women
* Allergy to propofol
* Previous diagnosis or suspected malignant hyperthermia
* Patients with a known sensitivity to any of the IMPs or other halogenated anaesthetics
* Concomitant therapy with glibenclamide or nicorandil (medications that may interfere with preconditioning)
* Inclusion in another clinical trial of an investigational medicinal product within the last 3 months.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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London School of Hygiene and Tropical Medicine

OTHER

Sponsor Role collaborator

Guy's and St Thomas' NHS Foundation Trust

OTHER

Sponsor Role collaborator

King's College Hospital NHS Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dr Gudrun Kunst

Role: PRINCIPAL_INVESTIGATOR

King's College Hospital NHS Trust

Locations

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St Thomas' Hospital

London, , United Kingdom

Site Status NOT_YET_RECRUITING

Kings College Hospital NHS Foundation Trust

London, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Kimberley Potter

Role: CONTACT

02079272505 ext. 2505

Richard Evans

Role: CONTACT

02072972665 ext. 2665

Facility Contacts

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Martin John

Role: primary

Gudrun Kunst

Role: primary

References

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Milne B, John M, Evans R, Robertson S, O Scanaill P, Murphy GJ, Landoni G, Marber M, Clayton T, Kunst G. Comparison between propofol and total inhalational anaesthesia on cardiovascular outcomes following on-pump cardiac surgery in higher-risk patients: a randomised controlled pilot and feasibility study. Open Heart. 2024 May 9;11(1):e002630. doi: 10.1136/openhrt-2024-002630.

Reference Type DERIVED
PMID: 38724266 (View on PubMed)

Other Identifiers

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2019-000171-16

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

216646

Identifier Type: OTHER

Identifier Source: secondary_id

KCH-PRO:19/001

Identifier Type: -

Identifier Source: org_study_id

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