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CholedocholithiasisPhase 4NCT02027311

Etomidate vs. Midazolam for Sedation During ERCP

A Phase 4 study testing Etomidate, Midazolam and Meperidine in people with Choledocholithiasis and Cholangiocarcinoma, run by Cheju Halla General Hospital at 1 site in South Korea.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Recently up-coming drug, etomidate which is a modulator of GABA(gamma-Aminobutyric acid)-A receptor has been known that it maintains the appropriate sedative levels and affects little effects on respiratory system. Read more about this study

Who is it for?
Ages 20 to 90 years
What is being tested?
Etomidate, Midazolam and Meperidine
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
63 participants
Where
1 siteSouth Korea
Study dates
Apr 2013to Aug 2013
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 20 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • All patients who are scheduled diagnositic or therapeutic ERCP.
  • Age : more than 20 and less than 90 years old
  • ASA(American Society of Anesthesiologists) classificiation : I, II, III

Who cannot join

  • Refuse to be enrolled
  • ASA American Society of Anesthesiologists)classification IV, V
  • Breast feeder
  • The mentally ill
  • Drug abuser
  • Hypersensitivity to sedative or opioids
Show all 14Show fewer
  • Alcohol intoxication or dependency
  • Body mass index (BMI) 36kg/m2 or more
  • Unstable vital sign
  • tachypnea, respiration rate more than 25/min or less than 10/min
  • Oxygen saturation : 90% or less
  • Systolic blood pressure : less than 90 mmHg or more than 180 mmHg
  • Diastolic blood pressure : less than 50 mmHg or more than 100 mmHg
  • Heart rate : more than 120 beat/min or less than 50 beat/min.

Trial locations and contacts

1 site in 1 country.

South Korea1 site
  • 1Digestive Disease Center and Department of Internal Medicine, Cheju Halla General Hospital

    Jeju City, Jeju Special Self-Governing Province, 690-766

Other trials in South Korea

About this study

Official title: Etomidate With Meperidine vs Midazolam With Meperidine for Sedation During Endodscopic Retrograde Cholangiopancreatogram (ERCP)

Recently up-coming drug, etomidate which is a modulator of GABA(gamma-Aminobutyric acid)-A receptor has been known that it maintains the appropriate sedative levels and affects little effects on respiratory system.

The investigators are now trying to investigate that etomidate with meperidine combination regimen is superior to the midazolam with meperidine more effective and less harm on sedation during the ERCP procedure.

Read the detailed description

ERCP (Endoscopic retrograde cholangiopancreatogram) is an uncomfortable and time-consuming procedure compared to other endoscopic procedures. Most ERCP procedure had been performed in sedation using tranquilizers and pain-killers.

Until recently, midazolam and opioid combination regimen recognized as a standard therapy is widely used, but the sedative effect is insufficient and intermittent paradoxical reaction has been questioned. Another drug, such as propofol, has been known that the sedative effect is superior one of the midazolam but disappointed due to narrow therapeutic range of respiratory distress and absence of antagonist. Meanwhile, recently up-coming drug, etomidate which is a modulator of GABA-A receptor has been known that it maintains the appropriate sedative levels and affects little effects on respiratory system.

For these advantages, this short acting sedative drug has been widely used in the emergency room during minor operation and in the operation room for induction. However, research on the efficacy during ERCP was not yet published.

In this regards, the purpose of the investigators study is to prove the efficacy of etomidate for sedation and to establish new evidence based sedation guidelines during ERCP procedure.

Being tested
Etomidate, Midazolam, Meperidine
Keywords
Endoscopic Retrograde Cholangiopancreatography (ERCP), Conscious Sedation, etomidate, midazolam
Medical subject headings
Choledocholithiasis, Cholangiocarcinoma, Pancreatitis, Pancreatic Neoplasms

What participants receive

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

  • EtomidateDrug

    Also called Etomidate lipro IV

    This cohort would be administered etomidate with meperidine. The initial dose of etomidate is 0.1mg/kg IV and meperidine, 25mg. Additional dose of etomidate is 2mg(1cc). In old age cased, more than 65 years old, 30% of initial dose discounted.

  • MidazolamDrug

    This cohort would be administered midazolam with meperidine. The initial dose of midazolam is 0.06mg/kg IV and meperidine 50mg IV. Additional dose is 1mg of midazolam. In the elders, more than 65 years old, initial dose was declined to 70%.

  • MeperidineDrug

    Also called Pethidine

    Both groups were administered same dose of meperidinie 50mg. Then elders > 80 years old were administered 25mg iv bolus.

Study groups in NCT02027311
Study groupRoleWhat they receive
EtomidateExperimentalThis cohort would be administered etomidate with meperidine. The initial dose of etomidate is 0.1mg/kg IV and meperidine, 25mg. Additional dose of etomidate is 2mg(1cc). In old age cased, more than 65 years old, 30% of initial dose discounted.
Receives: Drug: Etomidate; Drug: Meperidine
MidazolamExperimentalThis cohort would be administered midazolam with meperidine. The initial dose of midazolam is 0.06mg/kg IV and meperidine 50mg IV. Additional dose is 1mg of midazolam. In the elders, more than 65 years old, initial dose was declined to 70%.
Receives: Drug: Midazolam; Drug: Meperidine

What is being measured

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

  1. Number of Intervention

    The frequency of intervention which was defined as any restraint of the patient's head, arms, or legs if they became agitated, or if patient movement was not controlled with verbal instruction from the endoscopist during the whole intraoperative phases.

    Measured: Throughout the whole ERCP procedure

Secondary outcomes (1)
  1. Event of Hypoxia

    Hypoxia defined as peripheral blood oxygen saturation measured by pulse oxymeter < 90%

    Measured: Every 5min in Preoperative, intraoperative phase and 15 min in Recovery phase

Timeline

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

  1. First posted6 Jan 2014 (estimated)
  2. Study startApr 2013
  3. Primary completionAug 2013
  4. Study completionAug 2013

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
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
63 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02027311
Sponsor's protocol ID
ETOMI-1
Status last verified
Jun 2015
First submitted
16 Apr 2013
Last updated
29 Jun 2015
Data monitoring committee
Yes

Publications

  • Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy; Lichtenstein DR, Jagannath S, Baron TH, Anderson MA, Banerjee S, Dominitz JA, Fanelli RD, Gan SI, Harrison ME, Ikenberry SO, Shen B, Stewart L, Khan K, Vargo JJ. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2008 Nov;68(5):815-26. doi: 10.1016/j.gie.2008.09.029. No abstract available.

    PubMed 18984096
  • Yamazaki N, Ogawa K. [Dopamine-beta-hydroxylase (DBH)]. Kokyu To Junkan. 1976 Nov;24(11):949-55. No abstract available. Japanese.

    PubMed 1034320
  • Bell GD. Review article: premedication and intravenous sedation for upper gastrointestinal endoscopy. Aliment Pharmacol Ther. 1990 Apr;4(2):103-22. doi: 10.1111/j.1365-2036.1990.tb00455.x.

    PubMed 2104078
  • Galletly D, Forrest P, Purdie G. Comparison of the recovery characteristics of diazepam and midazolam. Br J Anaesth. 1988 Apr;60(5):520-4. doi: 10.1093/bja/60.5.520.

    PubMed 3377928
  • Yuksel O, Parlak E, Koklu S, Ertugrul I, Tunc B, Sahin B. Conscious sedation during endoscopic retrograde cholangiopancreatography: midazolam or midazolam plus meperidine? Eur J Gastroenterol Hepatol. 2007 Nov;19(11):1002-6. doi: 10.1097/MEG.0b013e3282cf5167.

    PubMed 18049171
  • Radaelli F, Meucci G, Terruzzi V, Spinzi G, Imperiali G, Strocchi E, Lenoci N, Terreni N, Mandelli G, Minoli G. Single bolus of midazolam versus bolus midazolam plus meperidine for colonoscopy: a prospective, randomized, double-blind trial. Gastrointest Endosc. 2003 Mar;57(3):329-35. doi: 10.1067/mge.2003.104.

    PubMed 12612511
  • Reimann FM, Samson U, Derad I, Fuchs M, Schiefer B, Stange EF. Synergistic sedation with low-dose midazolam and propofol for colonoscopies. Endoscopy. 2000 Mar;32(3):239-44. doi: 10.1055/s-2000-134.

    PubMed 10718390
  • Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, Kareken D. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc. 2002 Jun;55(7):815-25. doi: 10.1067/mge.2002.124636.

    PubMed 12024134
  • Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009 Feb 4;301(5):489-99. doi: 10.1001/jama.2009.56. Epub 2009 Feb 2.

    PubMed 19188334
  • Jung M, Hofmann C, Kiesslich R, Brackertz A. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam. Endoscopy. 2000 Mar;32(3):233-8. doi: 10.1055/s-2000-96.

    PubMed 10718389
  • Falk J, Zed PJ. Etomidate for procedural sedation in the emergency department. Ann Pharmacother. 2004 Jul-Aug;38(7-8):1272-7. doi: 10.1345/aph.1E008. Epub 2004 Jun 1.

    PubMed 15173551
  • Hunt GS, Spencer MT, Hays DP. Etomidate and midazolam for procedural sedation: prospective, randomized trial. Am J Emerg Med. 2005 May;23(3):299-303. doi: 10.1016/j.ajem.2005.02.042.

    PubMed 15915401
  • Denny MA, Manson R, Della-Giustina D. Propofol and Etomidate are Safe for Deep Sedation in the Emergency Department. West J Emerg Med. 2011 Nov;12(4):399-403. doi: 10.5811/westjem.2011.5.2099.

    PubMed 22224127
  • Miner JR, Martel ML, Meyer M, Reardon R, Biros MH. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med. 2005 Feb;12(2):124-8. doi: 10.1197/j.aem.2004.08.054.

    PubMed 15692132
  • Ruth WJ, Burton JH, Bock AJ. Intravenous etomidate for procedural sedation in emergency department patients. Acad Emerg Med. 2001 Jan;8(1):13-8. doi: 10.1111/j.1553-2712.2001.tb00539.x.

    PubMed 11136141

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Etomidate, Midazolam and Meperidine in people with Choledocholithiasis and Cholangiocarcinoma, run by Cheju Halla General Hospital at 1 site in South Korea.

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 3 inclusion and 14 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: finished, as of the sponsor's last update on 29 Jun 2015. 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 South Korea. 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 29 Jun 2015). 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?

Number of Intervention (time frame: Throughout the whole ERCP procedure). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02027311, which also lists 26 linked publications.

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 29 Jun 2015.

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