The Effect of Anesthesia Management on Optic Nerve Sheath Diameter in the Ercp Procedures

NCT ID: NCT04910087

Last Updated: 2021-11-09

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

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-01

Study Completion Date

2021-12-15

Brief Summary

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Aim: To compare the effect of procedural anesthesia management with ketofol and propofol on the sonographic optic nerve sheath diameter in the endoscopic retrograde cholangiopancreatography (ERCP) procedures.

Detailed Description

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Adequate visualization of the gastrointestinal mucosa during endoscopic retrograde cholangiopancreatography (ERCP) requires distention of the intestinal lumen by gas insufflation. High intraluminal pressures can increase intraabdominal pressure, leading to an increase in intracranial pressure. Ultrasonographic measurement of the optic nerve sheath diameter is a simple, non-invasive, and reliable technique for assessing intracranial pressure. Propofol, a sedative-hypnotic agent with rapid onset and short duration of action, is often used.Theoretically, the combination of ketamine and propofol may maintain sedation efficacy while reducing cardiovascular side effects through dose reduction and due to its synergistic effects.

The aim of this study is to demonstrate whether our anesthesia management has an effect on ICP change by measurement of optic nerve sheath diameter, predicting that insufflation performed for imaging during the ERCP procedure increase intraabdominal pressure, and frequently observed situations such as insufficient sedation, prone position, coughing and Valsalva during the procedure increase intracranial pressure (ICP).

Conditions

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Cholangiopancreatography, Endoscopic Retrograde Intracranial Pressure Optic Nerve Sheath Diameter Ketofol Propofol

Keywords

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Cholangiopancreatography, Endoscopic Retrograde Intracranial Pressure optic nerve sheath diameter ketofol propofol

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective randomized double blinded study
Primary Study Purpose

SCREENING

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Group K: Ketofol

A ketofol mixture of 15 cc propofol 2%, 2 cc ketamine 50 mg/ml, and 13 cc serum saline will be prepared in a 50 cc non-transparent syringe and delivered to the patient intravenously through perfuser device. (at a ratio of 100 mg ketamine/300 mg propofol) After the loading dose is administered at 1 mg/kg IV in 5 minutes based on propofol, 0.5 cc/kg/hour ketofol infusion will be initiated.

If patients cannot tolerate the ERCP procedure or have a BIS value \>85 or FPS (Faces Pain Scale)\> 3, 0.25 mg/kg propofol will be administered as a separate IV push.

Group Type ACTIVE_COMPARATOR

Sonographic optic nerve sheath diameter measurement

Intervention Type DIAGNOSTIC_TEST

With the linear ultrasound probe operating at 11 MHz in B mode, it will be measured in 2 planes, 3.0 mm behind the optic disc, the transverse plane where the probe is placed horizontally and the sagittal plane where the probe is placed vertically. Then, the average of these measurements will be recorded for both eyes every 10 minutes.

Group P: Propofol

A propofol mixture of 15 cc propofol 2% and 15 cc serum saline will be prepared in a 50 cc non-transparent syringe and delivered to the patient intravenously through the perfuser device.

After the loading dose is administered at 1 mg/kg IV propofol in 5 minutes ,0.5 cc/kg/hour propofol infusion will be initiated.

If patients cannot tolerate the ERCP procedure or have a BIS value \>85 or FPS (Faces Pain Scale)\> 3, 0.25 mg/kg propofol will be administered as a separate IV push

Group Type ACTIVE_COMPARATOR

Sonographic optic nerve sheath diameter measurement

Intervention Type DIAGNOSTIC_TEST

With the linear ultrasound probe operating at 11 MHz in B mode, it will be measured in 2 planes, 3.0 mm behind the optic disc, the transverse plane where the probe is placed horizontally and the sagittal plane where the probe is placed vertically. Then, the average of these measurements will be recorded for both eyes every 10 minutes.

Interventions

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Sonographic optic nerve sheath diameter measurement

With the linear ultrasound probe operating at 11 MHz in B mode, it will be measured in 2 planes, 3.0 mm behind the optic disc, the transverse plane where the probe is placed horizontally and the sagittal plane where the probe is placed vertically. Then, the average of these measurements will be recorded for both eyes every 10 minutes.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing ERCP procedure
* ASA score of I, II, and III

Exclusion Criteria

* chronic lung disease
* renal or hepatic failure
* uncontrolled comorbidities (diabetes mellitus, hypertension, etc.)
* central nervous system disease
* pregnancy
* undergoing optic nerve surgery
* glaucoma or increased intraocular pressure, and retinal detachment
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ankara City Hospital Bilkent

OTHER

Sponsor Role lead

Responsible Party

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ismail aytaç

Anesthesiology Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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ismail aytac

Role: PRINCIPAL_INVESTIGATOR

Ankara City Hospital Bilkent

Locations

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Ankara City Hospital

Ankara, , Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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ismail aytac

Role: CONTACT

Phone: +905056340369

Email: [email protected]

ismail aytaç

Role: CONTACT

Email: [email protected]

Facility Contacts

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İsmail Aytac

Role: primary

Other Identifiers

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E1/1786/2021

Identifier Type: -

Identifier Source: org_study_id