Intranasal Dexmedetomidine vs. Standard of Care for Emergency Department (ED) Procedural Sedation in the Older Adult

NCT ID: NCT06370442

Last Updated: 2024-04-22

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

NOT_YET_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-01

Study Completion Date

2025-09-01

Brief Summary

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The purpose of the study is to determine if intranasal dexmedetomidine could be an alternative to the current standard of care (injectable benzodiazepines or antipsychotics) for sedation prior to computerized tomography (CT) or magnetic resonance imaging (MRI) in those greater than or equal to 65 years of age (older adults) that are seen in the Emergency Department (ED).

Detailed Description

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Conditions

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Altered Mental Status

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Lorazepam

Group Type ACTIVE_COMPARATOR

Lorazepam

Intervention Type DRUG

0.5mg IV

Haloperidol

Group Type ACTIVE_COMPARATOR

Haloperidol

Intervention Type DRUG

0.5mg IV

IN Dex

Group Type EXPERIMENTAL

Dexmedetomidine

Intervention Type DRUG

Intranasal dexmedetomidine, 100mcg

Interventions

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Dexmedetomidine

Intranasal dexmedetomidine, 100mcg

Intervention Type DRUG

Lorazepam

0.5mg IV

Intervention Type DRUG

Haloperidol

0.5mg IV

Intervention Type DRUG

Other Intervention Names

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Precedex Ativan Haldol

Eligibility Criteria

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Inclusion Criteria

* 65 years of age and older
* Patients in need of sedation prior to either a computerized tomography (CT) or magnetic resonance imaging (MRI)

Exclusion Criteria

* Patients who weigh \< 50 kg
* Cardiac arrhythmias or QTc \>450
* Intravenous access not standard of care or unable to obtain
* Patients with any allergies or contraindications to dexmedetomidine, haloperidol (i.e. patients diagnosed with Parkinson's) or lorazepam
* Patients with low blood pressure, defined as a less than 100/60 mmHg
* Patients with bradycardia (Heart rate \< 60 bpm)
* Patients presenting with chief complaint of respiratory distress/failure
* Intranasal administration contradictions: nasal septal abnormalities, nasal trauma, epistaxis, excessive nasal mucus or blood, and intranasal damage, recent use of nasally administered vasoconstrictors such as cocaine, oxymetazoline, and phenylephrine
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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State University of New York - Upstate Medical University

OTHER

Sponsor Role lead

Responsible Party

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Jay Brenner

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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William Paolo, MD

Role: STUDY_CHAIR

State University of New York - Upstate Medical University

Central Contacts

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Jay M Brenner, MD

Role: CONTACT

315-464-1861

Jaylan Hayes, PharmMD

Role: CONTACT

315-464-9924

References

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Kennedy M, Koehl J, Gao J, Ciampa KA, Hayes BD, Camargo CA Jr. Use of antipsychotic and sedative medications in older patients in the emergency department. J Am Geriatr Soc. 2022 Mar;70(3):731-742. doi: 10.1111/jgs.17590. Epub 2021 Nov 25.

Reference Type RESULT
PMID: 34820831 (View on PubMed)

Tobias JD, Leder M. Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi J Anaesth. 2011 Oct;5(4):395-410. doi: 10.4103/1658-354X.87270.

Reference Type RESULT
PMID: 22144928 (View on PubMed)

Kienitz R, Kay L, Beuchat I, Gelhard S, von Brauchitsch S, Mann C, Lucaciu A, Schafer JH, Siebenbrodt K, Zollner JP, Schubert-Bast S, Rosenow F, Strzelczyk A, Willems LM. Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability. CNS Drugs. 2022 Sep;36(9):951-975. doi: 10.1007/s40263-022-00940-2. Epub 2022 Aug 16.

Reference Type RESULT
PMID: 35971024 (View on PubMed)

Amore M, D'Andrea M, Fagiolini A. Treatment of Agitation With Lorazepam in Clinical Practice: A Systematic Review. Front Psychiatry. 2021 Feb 22;12:628965. doi: 10.3389/fpsyt.2021.628965. eCollection 2021.

Reference Type RESULT
PMID: 33692709 (View on PubMed)

Yuen VM, Hui TW, Irwin MG, Yao TJ, Chan L, Wong GL, Shahnaz Hasan M, Shariffuddin II. A randomised comparison of two intranasal dexmedetomidine doses for premedication in children. Anaesthesia. 2012 Nov;67(11):1210-6. doi: 10.1111/j.1365-2044.2012.07309.x. Epub 2012 Sep 5.

Reference Type RESULT
PMID: 22950484 (View on PubMed)

Baumgartner K, Groff V, Yaeger LH, Fuller BM. The use of dexmedetomidine in the emergency department: A systematic review. Acad Emerg Med. 2023 Mar;30(3):196-208. doi: 10.1111/acem.14636. Epub 2022 Dec 19.

Reference Type RESULT
PMID: 36448276 (View on PubMed)

Barends CRM, Driesens MK, Struys MMRF, Visser A, Absalom AR. Intranasal dexmedetomidine in elderly subjects with or without beta blockade: a randomised double-blind single-ascending-dose cohort study. Br J Anaesth. 2020 Apr;124(4):411-419. doi: 10.1016/j.bja.2019.12.025. Epub 2020 Feb 3.

Reference Type RESULT
PMID: 32029262 (View on PubMed)

Pastis NJ, Hill NT, Yarmus LB, Schippers F, Imre M, Sohngen W, Randall O, Callahan SP, Silvestri GA. Correlation of Vital Signs and Depth of Sedation by Modified Observer's Assessment of Alertness and Sedation (MOAA/S) Scale in Bronchoscopy. J Bronchology Interv Pulmonol. 2022 Jan 1;29(1):54-61. doi: 10.1097/LBR.0000000000000784.

Reference Type RESULT
PMID: 34238838 (View on PubMed)

Uusalo P, Seppanen SM, Jarvisalo MJ. Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients. Drugs Aging. 2021 May;38(5):441-450. doi: 10.1007/s40266-021-00846-6. Epub 2021 Mar 16.

Reference Type RESULT
PMID: 33728561 (View on PubMed)

Gupta A, Dalvi NP, Tendolkar BA. Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients: A prospective randomized double blind trial. J Anaesthesiol Clin Pharmacol. 2017 Apr-Jun;33(2):236-240. doi: 10.4103/joacp.JOACP_204_16.

Reference Type RESULT
PMID: 28781452 (View on PubMed)

Sinnott J, Holthaus CV, Ablordeppey E, Wessman BT, Roberts BW, Fuller BM. The Use of Dexmedetomidine in the Emergency Department: A Cohort Study. West J Emerg Med. 2021 Aug 22;22(5):1202-1209. doi: 10.5811/westjem.2021.4.50917.

Reference Type RESULT
PMID: 34546899 (View on PubMed)

Other Identifiers

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2137695

Identifier Type: -

Identifier Source: org_study_id

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