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AnesthesiaPhase 4NCT01017237

Dexmedetomidine Sedation With Third Molar Surgery

A Phase 4 study testing Dexmedetomidine, Midazolam and Ketamine in people with Anesthesia, run by University of North Carolina, Chapel Hill at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Intravenous sedation is used frequently for the relief of pain and anxiety associated with oral surgical procedures performed under local anesthesia. The purpose of this study is to learn about patient and surgeon satisfaction with sedation using Dexmedetomidine in combination with midazolam alone or with midazolam… Read more about this study

Who is it for?
Ages 18 to 30 yearsHealthy volunteers can take part
Conditions the study is for
Anesthesia
What is being tested?
Dexmedetomidine, Midazolam and Ketamine
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
18 participants
Where
1 siteUnited States
Study dates
Jul 2009to Dec 2011
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 30 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • American Society of Anesthesiology (ASA) physical status I and II
  • Four asymptomatic third molars indicated for removal

Who cannot join

  • Clinical history or ECG evidence of:
  • cardiac dysrhythmia or heart block
  • ischemic heart disease
  • asthma
  • sleep apnea
  • impaired liver, renal, or mental function
Show all 9Show fewer
  • chronic sedative or analgesic use
  • allergies to any of the study drugs
  • history of pericoronal infection with third molars

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of North Carolina School of Dentistry

    Chapel Hill, North Carolina, 27599

Other trials in United States

About this study

Official title: Comparison of the Effectiveness of Sedation With i.v. Dexmedetomidine in Combination With Midazolam Alone or Midazolam and Low Dose Ketamine for Extraction of Third Molars.

Intravenous sedation is used frequently for the relief of pain and anxiety associated with oral surgical procedures performed under local anesthesia. The purpose of this study is to learn about patient and surgeon satisfaction with sedation using Dexmedetomidine in combination with midazolam alone or with midazolam plus low dose ketamine while having wisdom teeth removed.

The sedation produced by dexmedetomidine is unique in that it mimics natural sleep, a unique quality not shared by other drugs. Dexmedetomidine is often used in anesthesia in hospital operating rooms and has been approved by the US Food and Drug Administration for the use planned in this study.

Read the detailed description

Subjects who have been screened medically and are scheduled for third molar surgery in the University of North Carolina (UNC)Oral and Maxillofacial Surgery (OMFS) clinic will be asked to volunteer for the study by the evaluating OMFS resident or attending physician. No additional x-rays will be taken other than those usually indicated for 3rd molar surgery. Informed consent will be obtained by study investigators.

Subjects will be instructed to fast for at least 8 hours prior to their appointment. Surgery will be performed in the Oral \& Maxillofacial Surgery operating/sedation clinic where all monitoring equipment as well as emergency equipment is readily available, including the ability to ventilate the patient with oxygen (bag-mask), the ability to intubate, resuscitation drugs and equipment including a defibrillator. Patients will be positioned in a semi-reclining position in the dental chair and all monitors applied. A 20 gauge i.v. catheter will be placed and normal saline infusion attached. Supplemental oxygen will be administered via nasal cannula at 3 liters per minute. A picture will then be shown for recall testing. Pulse rate, arterial oxygen saturation (SpO2), respiratory rate, blood pressure, end-tidal CO2 (ETCO2), Ramsey Sedation Score (RSS sedation score) and Bispectral Index Scale (BIS) value will be recorded as a baseline and at 5 minute intervals during the procedure. Any SpO2 values below 90% as well as any episodes of apnea greater than 20 seconds will be recorded. Monitoring and recording of all data will be done by one of the investigators. Data will be recorded on pre-printed data forms. The surgical procedure will be performed by an oral and maxillofacial surgery resident physician.

Following the administration of 0.12 mg/kg of dexamethasone , dexmedetomidine will be infused at a rate of 6 mcg/kg/hr for four minutes; resulting in a loading dose of 0.4 mcg/kg. All of the above parameters will again be obtained and recorded. Patients will be randomly assigned by block randomization to receive either midazolam 0.04 mg/kg i.v. (50 patients), or midazolam 0.04 mg/kg plus 0.25 mg/kg of ketamine (50 patients). The operating surgeon and the patient will be blinded as to which protocol is being used. A dexmedetomidine infusion of 0.5 mcg/kg/hr will be initiated and continued until the completion of surgery. At this point local anesthesia will be administered in all four quadrants. Pain reaction during injections will be recorded. When efficacy of local anesthesia has been confirmed, surgery will commence. The surgery will be interrupted at 15 and 30 minutes to show a picture for recall testing by an investigator. If at any point the patient is deemed to be uncomfortable or uncooperative due to inadequate sedation, the protocol will be broken and additional sedation administered as per usual standards. The rescue therapy may include additional midazolam, ketamine, narcotic or propofol at the discretion of the anesthetist/sedationist. At the conclusion of surgery the dexmedetomidine infusion will be discontinued and the patient will be attended by a recovery nurse for collection of postoperative data. During recovery the physiologic parameters will be recorded at 10 minute intervals. When the patient achieves a recovery Aldrete score of >9, they will be asked by an investigator to recall pictures for amnesia assessment, and asked to assess patient satisfaction before leaving with an escort. The patient will be contacted on the day following surgery by phone or e-mail by one of the investigators to test for recall of pictures shown (amnesia testing) and patient satisfaction

Conditions
Anesthesia
Keywords
Dexmedetomidine sedation, Oral surgery sedation, Dexmedetomidine amnesia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • DexmedetomidineDrug

    Also called Precedex

    Dexmedetomidine will be infused at a rate of 6 mcg/kg/hr for four minutes; resulting in a loading dose of 0.4 mcg/kg, Followed by an infusion of 0.5 mcg/kg/hr will be initiated and continued until the completion of surgery.

  • MidazolamDrug

    Also called Versed

    Midazolam 0.04 mg/kg i.v. administered after dexmedetomidine loading dose.

  • KetamineDrug

    Also called Ketalar

    Ketamine 0.25 mg/ml administered i.v. following the dexmedetomidine loading dose and the midazolam.

Study groups in NCT01017237
Study groupRoleWhat they receive
Dex plus midazolamActive comparatorDexmedetomidine loading dose of 0.4 mcg/kg followed by an infusion of 0.5 mcg/kg/hr plus midazolam 0.04 mg/kg i.v.
Receives: Drug: Dexmedetomidine; Drug: Midazolam
Dex plus midazolam and ketamineActive comparatorDexmedetomidine loading dose of 0.4 mcg/kg followed by an infusion of 0.5 mcg/kg/hr plus midazolam 0.04 mg/kg and 0.25 mg/kg ketamine i.v.
Receives: Drug: Dexmedetomidine; Drug: Midazolam; Drug: Ketamine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Amnesia: Lack of Picture Recall Shown Prior to Sedation.

    Subjects were shown pictures of familiar objects prior to sedation, after the bolus dose of dexmedetomidine was administered, at 15 minutes and 30 minutes into the surgery and at the end of surgery. Subjects were shown a page containing multiple pictures to evaluate whether they could remember any of them. No recall demonstrating the presence of amnesia during that portion of the procedure. This process was repeated the day following surgery

    Measured: Day of surgery prior to discharge

  2. Amnesia: Lack of Recall One Day After Surgery of The Picture That Was Shown Prior to Sedation.

    Lack of recall of picture shown indicates presence of amnesia the day following surgery.

    Measured: One day after surgery

  3. Amnesia: Lack of Picture Recall Following Dexmedetomidine Infusion Plus Midazolam.

    Percentage of patients unable to recall picture

    Measured: Day of Surgery prior to discharge

  4. Amnesia: Lack of Recall One Day After Surgery of The Picture That Was Shown Following Dexmedetomidine Infusion Plus Midazolam.

    Inability to recall picture shown at this time indicates presence of amnesia on the day following surgery.

    Measured: One day after surgery

  5. Amnesia: Lack of Picture Recall Shown 15 Minutes Into Surgery

    Lack of recall of picture shown at this time indicates presence of amnesia

    Measured: Day of Surgery prior to discharge

  6. Amnesia: Lack of Recall One Day After Surgery of The Picture That Was Shown 15 Minutes Into Surgery.

    Lack of recall of picture demonstrates presence of amnesia on day following surgery

    Measured: One day after surgery

  7. Amnesia: Lack of Picture Recall Shown 30 Minutes Into Surgery

    Lack of recall of picture shown indicates presence of amnesia

    Measured: Day of Surgery prior to discharge

  8. Primary Title: Amnesia: Lack of Recall One Day After Surgery of The Picture That Was Shown 30 Minutes Into Surgery.

    Lack of recall of picture shown indicates presence of amnesia on day following surgery.

    Measured: One day after surgery

  9. Amnesia: Lack of Picture Recall at Surgery End Time.

    Lack of recall of picture shown indicates presence of amnesia

    Measured: Day of surgery prior to discharge

  10. Amnesia: Lack of Recall One Day After Surgery of The Picture That Was Shown at Surgery End Time.

    Lack of recall of picture shown indicates presence of amnesia on day following surgery.

    Measured: One day after surgery

Secondary outcomes (14)
  1. Respiratory Parameters: Respiratory Rate

    Respirations per minute

    Measured: Immediately prior to sedation

  2. Respiratory Parameters: Respiratory Rate

    Rate of respirations

    Measured: During surgical procedure

  3. Respiratory Parameters: Oxyhemoglobin Saturation

    Oxyhemoglobin saturation per pule oximeter

    Measured: Immediately prior to surgery

  4. Respiratory Parameters: Oxyhemoglobin Saturation

    Oxyhemoglobin saturation per pulse oximetry

    Measured: During surgical procedure

  5. Respiratory Parameters: End-tidal Carbon Dioxide

    Measured via capnography at nares

    Measured: Immediately prior to sedation

  6. Respiratory Parameters: End-tidal Carbon Dioxide

    Measured by capnography at nares

    Measured: Duration of surgery

  7. Mean Arterial Blood Pressure

    Blood pressure per automated monitor

    Measured: Immediately prior to surgery

  8. Mean Arterial Blood Pressure

    Measured using automated blood pressure monitor

    Measured: During duration of surgery

  9. Heart Rate

    Heart rate per EKG monitor

    Measured: Prior to sedation

  10. Heart Rate

    Per EKG monitor

    Measured: Duration of surgery

  11. Surgeon Satisfaction With Sedation Technique

    Numerical value on scale of 1-5 from Very dissatisfied (1) to Extremely satisfied (5)

    Measured: After surgery completed: day of surgery, within 15 minutes

  12. Patient Satisfaction With Sedation Technique

    Rating of how satisfied the patient was with their sedation on a scale of 1-5 with 1 being very dissatisfied and 5 being extremely satisfied

    Measured: after completion of surgery (within 15 minutes)

  13. Ramsey Sedation Scale Score

    Rating of depth of sedation by sedationist. Scale 1 - 6, 1 being widw awake and 6 being non-responsive

    Measured: During surgical procedure

  14. Bispectral Index Score (BIS)

    Bispectral Index (BIS) measures level of consciousness by algorithmic analysis of the patient's electroencephalogram (EEG) during anesthesia and sedation. The BIS can range from 0 (equivalent to EEG silence) to 100 (equivalent to fully awake and alert). A BIS value of 40-60 indicates an adequate general anesthesia state.

    Measured: During surgery duration.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Nov 2009 (estimated)
  2. Study startJul 2009
  3. Primary completionDec 2011
  4. Study completionDec 2011

Why it stopped: Protocol proved to be ineffective for adequate sedation for third molar surgery.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
18 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01017237
Sponsor's protocol ID
08-2157
Status last verified
Apr 2012
First submitted
14 Aug 2009
Last updated
17 Jun 2013
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Dexmedetomidine, Midazolam and Ketamine in people with Anesthesia, run by University of North Carolina, Chapel Hill at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 17 Jun 2013. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 17 Jun 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Amnesia: Lack of Picture Recall Shown Prior to Sedation. (time frame: Day of surgery prior to discharge). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Jun 2013.

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Dexmedetomidine Sedation With Third Molar Surgery | AzTrials