Emergence Agitation in Paediatric Day Care Surgery

NCT ID: NCT06571890

Last Updated: 2024-08-26

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

93 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-03-29

Study Completion Date

2020-09-30

Brief Summary

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Emergence agitation is a significant and persistent challenge in paediatric anaesthesia, especially in children of preschool age.

In this study, the investigators examined whether anaesthesia titration with either a sleep depth monitor or a pain monitor would result in changed postoperative agitation rates, measured via the Richmond Agitation and Sedation Score (RASS).

93 children participated. The participants were divided into three groups: A conventional anaesthesia group, an EEG (Electroencephalography)- monitored and a pain-monitored group. The pain-monitored children received the most pain medication but were discharged at the same rate as the other children with unchanged rates of nausea and vomiting and less agitation than the sleep-monitored children.

Detailed Description

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Healthy preschool outpatients assigned for abdominal/inguinal hernia and cryptorchidism repairs participated after parental consent.

One group received standard anaesthesia induction and maintenance, according to the usual ward regimen. This was done with sevoflurane inhalation, fentanyl bolus and a laryngeal mask airway (Standard group, STD group)

The second group received standard anaesthesia as well only this time the sevoflurane titration was guided via the Nacotrend bispectral index monitor, towards a narcotrend index of 2-4. (Narcotrend group, NCT group)

The third group also received standard anaesthesia and was additionally monitored with a Mdoloris Anaesthesia Nociception Index (ANI) monitor for perioperative nociception. When a nociceptive threshold was exceeded, an extra bolus of fentanyl of 1 mcg/kg was given (ANI group)

All children were then escorted to the postoperative care unit for wakeup. A Richmond Agitation Sedation Scale score (RASS-score) was made every 15 minutes until discharge. This was analysed with Kaplan-Meyer mortality graph, along with usual statistics of secondary outcomes.

The children in the ANI group received the least fentanyl and were discharged no later than all the other children.

Conditions

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Postoperative Delirium Postoperative Agitation Anesthesia Pain Monitoring Heart Rate Variability Narcotrend Mdoloris Anesthesia Nociception Index

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard (STD)

Standard anaesthesia with Sevoflurane Inhalation anaesthesia, fentanyl and a laryngeal mask

Group Type NO_INTERVENTION

No interventions assigned to this group

Narcotrend (NCT)

Standard anaesthesia with Sevoflurane inhalation anaesthesia, fentanyl and a laryngeal mask. Sevoflurane concentration was titrated via a Narcotrend bispectral anaesthesia monitor.

Group Type EXPERIMENTAL

Narcotrend bispectral index anaesthesia monitor

Intervention Type DEVICE

A bispectral index anaesthesia monitor collects simplified EEG via forehead electrodes and displays an index of 0-100, where an index of 40-60 is considered optimal

Anaesthesia Nociception Index Monitor (ANI)

Standard anaesthesia with Sevoflurane inhalation anaesthesia, fentanyl and a laryngeal mask. Fentanyl dosage titrated with guidance from Mdoloris ANI monitor, a heart rate variability-based nociception monitor. When a threshold value is exceeded, additional fentanyl 1 mcg/kg is given

Group Type EXPERIMENTAL

Mdoloris Anaesthesia Nociception Monitor

Intervention Type DEVICE

A heart rate variability-based nociception monitor collects ECG-signal from electrodes on the patient's chest and displays an index of 0-100 where an index below 50 is considered nociceptive.

Interventions

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Narcotrend bispectral index anaesthesia monitor

A bispectral index anaesthesia monitor collects simplified EEG via forehead electrodes and displays an index of 0-100, where an index of 40-60 is considered optimal

Intervention Type DEVICE

Mdoloris Anaesthesia Nociception Monitor

A heart rate variability-based nociception monitor collects ECG-signal from electrodes on the patient's chest and displays an index of 0-100 where an index below 50 is considered nociceptive.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Day surgery for abdominal and urological procedures
* Children 1-6 years
* American Society of Anesthesiologist (ASA) scale 1- 2
* Airway management with laryngeal masks or facemasks
* Consent from both parents/legal representatives
* Rescue propofol is allowed

Exclusion Criteria

* Age less than 1 or older than 6 years
* ASA \> 2
* Endotracheal intubation;
* Lack of consent from both parents/legal representatives
* Daily intake of medications that interfered with the autonomic nervous system reactivity, for example, inhaled beta-agonists for bronchial asthma and total intravenous anaesthesia (TIVA).
Minimum Eligible Age

1 Year

Maximum Eligible Age

6 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Odense Patient Data Explorative Network

OTHER

Sponsor Role collaborator

University of Southern Denmark

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Line Gry Larsen

Role: PRINCIPAL_INVESTIGATOR

Anaeshtesiologic Intensive Ward V, Odense University Hospital

Locations

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Odense University Hospital

Odense, , Denmark

Site Status

Countries

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Denmark

Other Identifiers

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280482

Identifier Type: -

Identifier Source: org_study_id

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