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CoughPhase 4REMEXNCT02711904

Concentrations of Remifentanil for Extubation

A Phase 4 study testing Extubation U and Extubation T in people with Cough, run by Seganest at 1 site in Colombia.

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

Condition of the State: (terminated, recruiting, etc.) Terminated Study Design: Main Objective: Compare the frequency and intensity of coughing at the time of extubation with two infusions of remifentanil that predict a plasma concentration (PC) of 3 - 4 and 2 - 3 ng/ml, through the technique of target controlled… Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Cough
What is being tested?
Extubation U and Extubation T
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
110 participants
Where
1 siteColombia
Study dates
Jan 2011to Jul 2012
Phase
Phase 4
Are there results?
None posted in the registry

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 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • All patients aged 18-70 years
  • Risk Scale American Society of Anaesthesiologists physical status classification (ASA) I and II
  • Undergoing elective ear surgery

Who cannot join

  • Patients who are contraindicated remifentanil
  • Patients undergoing emergency surgery
  • Pulmonary Pathology (ASTHMA - COPD)
  • Index of body mass greater than 35
  • Background of respiratory failure three weeks prior to the procedure
  • Smokers

Trial locations and contacts

1 site in 1 country.

Colombia1 site
  • Instituto Para Niños Ciegos y Sordos del Valle del Cauca

    Cali, Valle del Cauca Department, 288 00

Other trials in Colombia

About this study

Official title: Effect of Two Plasma Concentrations of Remifentanil Through Target Controlled Anesthesia on Frequency and Intensity of Coughing During Extubation: Randomized Controlled Clinical Trial

Condition of the State: (terminated, recruiting, etc.) Terminated

Study Design: Main Objective:

Compare the frequency and intensity of coughing at the time of extubation with two infusions of remifentanil that predict a plasma concentration (PC) of 3 - 4 and 2 - 3 ng/ml, through the technique of target controlled anesthesia

Read the detailed description

Phase of the study:

Phase IV

Intervention:

Drug: U Extubation

Other Names:

Concentration 2 - 3 ng/ml Dose of remifentanil according to the randomization: Letter U between 2 - 3 ng/ml. The infusions that were used to reach the (PC) target were: Group U = 2 - 3 ng/ml. 20 years old - 6.0 mcg/Kg/h, 30 years old - 5.7 mcg/Kg/h, 40 years old - 5.3 mcg/kg/h, 50 years old - 5.0 mcg/kg/h, 60 years old - 4.6 mcg/kg/h, 70 years old - 4.3 mcg/kg/h, 80 years old - 4.0 mcg kg/h.

Drug: Extubation T

Other Names:

Concentration 3 - 4 ng/ml Dose of infusion of remifentanil to reach a (PC) 3 - 4 ng/ml, in the following manner: The assistant placed the infusion balloon in such a way that it could not be seen by the treating anesthesiologist, he proceeded to open the corresponding wrapping according to the consecutive which corresponds to the patient. The remifentanil dose was adjusted according to the randomization: Group T = 3 - 4 ng/ml. 20 years old - 9.0 mcg/Kg/h, 30 years old - 8.5 mcg/Kg/h, 40 years old - 8.0 mcg/kg/h, 50 years old - 7.5 mcg/kg/h, 60 years old - 7.0 mcg/kg/h, 70 years old - 6.5 mcg/kg/h, 80 years old - 6.0 mcg kg/h.

Number of arms:

2

Masking:

The patient had masking with regards to the anesthetic procedure from the unfamiliarity per se of the same and by agents used in this that induced anxiolysis and hypnosis.

To guarantee the masking to the viewer, which was the treating anesthesiologist, a nurse was trained in the adjustment of the infusion balloon. Ten minutes before concluding the procedure and by request of the anesthesiologist, the nurse proceeded to locate balloon in such a way that the infusion could not be seen by the anesthesiologist, then opened the envelope and adjusted the infusion according to the randomization (U) o (T). The evaluation of the cough, its intensity and the Ramsay were under the care of the anesthesiologist, who was unaware of the awakening infusion.

Allocation:

Two were allocated for the use: Concentration of remifentanil of 2 - 3 ng/ml (group U) and concentration of remifentanil of 3 - 4 ng/ml (group T).

Recruitment:

A patient was recruited between the period of January 2011 and July 2012.

Conditions
Cough
Being tested
Extubation U, Extubation T
Keywords
Extubation, Cough, Target Controlled Anesthesia (TACAN)
Medical subject headings
Cough

What participants receive

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

  • Extubation UDrug

    Also called Ultiva

    Dose of remifentanil according to the randomization; the infusions that were used to reach the PC target were:

    • 20 years old - 6.0 mcg/Kg/h
    • 30 years old - 5.7 mcg/Kg/h
    • 40 years old - 5.3 mcg/kg/h
    • 50 years old - 5.0 mcg/kg/h
    • 60 years old - 4.6 mcg/kg/h
    • 70 years old - 4.3 mcg/kg/h
    • 80 years old - 4.0 mcg kg/h.
  • Extubation TDrug

    Also called Ultiva

    Dose of infusion of remifentanil to reach a PC 3 - 4 ng/ml, in the following manner:

    The assistant placed the infusion balloon in such a way that it could not be seen by the treating anesthesiologist, he proceeded to open the corresponding wrapping according to the consecutive which corresponds to the patient.

    The remifentanil dose was adjusted according to the randomization:

    • 20 years old - 9.0 mcg/Kg/h
    • 30 years old - 8.5 mcg/Kg/h
    • 40 years old - 8.0 mcg/kg/h
    • 50 years old - 7.5 mcg/kg/h
    • 60 years old - 7.0 mcg/kg/h
    • 70 years old - 6.5 mcg/kg/h
    • 80 years old - 6.0 mcg kg/h.
Study groups in NCT02711904
Study groupRoleWhat they receive
Extubation UActive comparatorRemifentanil concentration between 2 - 3 ng/ml.
Receives: Drug: Extubation U
Extubation TExperimentalRemifentanil concentration between 3 - 4 ng/ml
Receives: Drug: Extubation T

What is being measured

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

  1. Cough

    Number of episodes and duration of cough that occur when the patient responds to verbal stimulus and extubated.

    Cough Scale

    • Grade 0 = No cough
    • Grade 1 = Mild (only episode of cough)
    • Grade 2 = Moderate (more than 1episode of cough during less than 5 seconds)
    • Grade 3 = Severe (More than one episode of cough that lasted more than 5 seconds or purposeless movements of the extremities).

    Measured: It is evaluated by the scale of cough over a two hour period after surgery: is assessed at 5 minutes turned off the halogenated inhalation anesthetics, thereafter every minute until the patient responds to verbal stimulus and can be extubated

Secondary outcomes (2)
  1. Wake time.

    When vaporizer where closed until the patient responds to the verbal stimulus and is extubated.

    Defined as the time taken to open eyes after having turned off the halogenated inhalation anesthetics.

    Measured: During two hours after surgery, five minutes after turning off halogenated inhaled anesthetics, then every minute until the patient opens his eyes and is extubated.

  2. Ramsay scale at the time of extubation

    Ramsay scale: score objective system for measuring drug-induced sedation

    • Score 1: Anxious or restless or both
    • Score 2: Cooperative, orientated and tranquil
    • Score 3: Responding to commands
    • Score 4: Brisk response to stimulus
    • Score 5: Sluggish response to stimulus
    • Score 6: No response to stimulus

    Measured: During two hours after surgery, the estimated time period during which the event was assessed five (5) minutes after every minute, until answered

Timeline

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

  1. First posted17 Mar 2016 (estimated)
  2. Study startJan 2011
  3. Primary completionJan 2011
  4. Study completionJul 2012

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
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
110 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02711904
Sponsor's protocol ID
SEGANEST
Acronym
REMEX
Status last verified
Mar 2016
First submitted
27 Aug 2013
Last updated
17 Mar 2016
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No: The individual data of the participants (IPD) were only available to the ethics committee of the institution.

Publications

  • Neelakanta G, Miller J. Minimum alveolar concentration of isoflurane for tracheal extubation in deeply anesthetized children. Anesthesiology. 1994 Apr;80(4):811-3. doi: 10.1097/00000542-199404000-00013.

    PubMed 8024135
  • Guler G, Akin A, Tosun Z, Eskitascoglu E, Mizrak A, Boyaci A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand. 2005 Sep;49(8):1088-91. doi: 10.1111/j.1399-6576.2005.00780.x.

    PubMed 16095449
  • Saghaei M, Reisinejad A, Soltani H. Prophylactic versus therapeutic administration of intravenous lidocaine for suppression of post-extubation cough following cataract surgery: a randomized double blind placebo controlled clinical trial. Acta Anaesthesiol Taiwan. 2005 Dec;43(4):205-9.

    PubMed 16450594
  • Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg. 2004 Oct;99(4):1253-1257. doi: 10.1213/01.ANE.0000132779.27085.52.

    PubMed 15385385
  • Fagan C, Frizelle HP, Laffey J, Hannon V, Carey M. The effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general anesthesia. Anesth Analg. 2000 Jul;91(1):201-5. doi: 10.1097/00000539-200007000-00038.

    PubMed 10866913
  • Tagaito Y, Isono S, Nishino T. Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology. 1998 Jun;88(6):1459-66. doi: 10.1097/00000542-199806000-00007.

    PubMed 9637637
  • Nishina K, Mikawa K, Maekawa N, Obara H. Fentanyl attenuates cardiovascular responses to tracheal extubation. Acta Anaesthesiol Scand. 1995 Jan;39(1):85-9. doi: 10.1111/j.1399-6576.1995.tb05597.x.

    PubMed 7725888
  • Mendel P, Fredman B, White PF. Alfentanil suppresses coughing and agitation during emergence from isoflurane anesthesia. J Clin Anesth. 1995 Mar;7(2):114-8. doi: 10.1016/0952-8180(94)00024-x.

    PubMed 7598918
  • Sant'Ambrogio G, Widdicombe J. Reflexes from airway rapidly adapting receptors. Respir Physiol. 2001 Mar;125(1-2):33-45. doi: 10.1016/s0034-5687(00)00203-6.

    PubMed 11240151
  • Lema FE, Tafur LA, Giraldo C, Delgado MA. [Incidence of cough after desflurane and sevoflurane administration through a laryngeal mask: a controlled clinical trial]. Rev Esp Anestesiol Reanim. 2010 Mar;57(3):141-6. doi: 10.1016/s0034-9356(10)70188-2. Spanish.

    PubMed 20422846
  • Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974 Jun 22;2(5920):656-9. doi: 10.1136/bmj.2.5920.656.

    PubMed 4835444
  • Grahame-Smith DG. How will knowledge of the human genome affect drug therapy? Br J Clin Pharmacol. 1999 Jan;47(1):7-10. doi: 10.1046/j.1365-2125.1999.00909.x. No abstract available.

    PubMed 10073732
  • Van Poucke GE, Bravo LJ, Shafer SL. Target controlled infusions: targeting the effect site while limiting peak plasma concentration. IEEE Trans Biomed Eng. 2004 Nov;51(11):1869-75. doi: 10.1109/TBME.2004.827935.

    PubMed 15536889
  • Tafur LA, Gómez JM, Parra LE. Validación de nomogramas de remifentanil y propofol para la administración de anestesia total endovenosa. Rev. Col. Anest. 2009; 37:21-8.

  • Mertens MJ, Olofsen E, Engbers FH, Burm AG, Bovill JG, Vuyk J. Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil-propofol interactions. Anesthesiology. 2003 Aug;99(2):347-59. doi: 10.1097/00000542-200308000-00016.

    PubMed 12883407

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Extubation U and Extubation T in people with Cough, run by Seganest at 1 site in Colombia.

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 6 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 17 Mar 2016. 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 Colombia. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Cough (time frame: It is evaluated by the scale of cough over a two hour period after surgery: is assessed at 5 minutes turned off the halogenated inhalation anesthetics, thereafter every minute until the patient responds to verbal stimulus and can be extubated). 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 NCT02711904, which also lists 33 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 17 Mar 2016.

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