Stress ResponsePhase 2/3NCT02917018
Effect of Dexmedetomidine on Stress Response and Emergence Agitation During Laparoscopic Surgery
A Phase 2/3 study testing Dexmedetomidine in people with Stress Response, run by Assiut University at 1 site in Egypt.
Trial summary
Emergence agitation is a post-anesthetic phenomenon that develops in the early phase of general anesthesia recovery, and is characterized by agitation, confusion, disorientation, and possible violent behavior. The incidence of emergence agitation is less common in adults as compared to pediatric patients. Read more about this study
- Who is it for?
- Ages 20 to 60 years
- Conditions the study is for
- Stress Response
- What is being tested?
- Dexmedetomidine
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 90 participants
- Where
- 1 siteEgypt
- Study dates
- May 2016to Dec 2016
- Phase
- Phase 2/3
- 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 20 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- ASA I - II Laparoscopic cholecystectomy under general anesthesia
Who cannot join
- Patients with cardiac disease, diabetes. reactive upper airway disease. allergies to dexmedetomidine. cognitive disorders. renal insufficiency. hepatic dysfunction. Chronic use of analgesics, cortisone or drugs known to interact with dexmedetomidine.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effect of Different Doses of Dexmedetomidine on Stress Response and Emergence Agitation After Laparoscopic Cholecystectomy in Adults
Emergence agitation is a post-anesthetic phenomenon that develops in the early phase of general anesthesia recovery, and is characterized by agitation, confusion, disorientation, and possible violent behavior. The incidence of emergence agitation is less common in adults as compared to pediatric patients. It may lead to serious consequences for the patient such as bleeding, falling, removal of catheters and self extubation, which lead to further complications like hypoxia and aspiration.
Despite its common occurrence, unclear etiology, and serious sequelae, emergence agitation has rarely been studied in adults.
Read more
The stress response to surgery is an unconscious response to tissue injury. Activation of the sympathetic nervous system, increase of catabolic hormone release and pituitary gland suppression are considered a response to surgical stress, in clinical practice these activities cause changes in heart rate, blood pressure and biochemical fluctuations of noradrenaline, adrenaline, dopamine, and cortisol. Above all, these fluctuations prolong hospitalization and delay patients discharge.
Dexmedetomidine is a highly selective alpha-2 receptor agonist having sedative, analgesic and sympatholytic properties. Decreased stress response to surgery ensuring a stable hemodynamic state is a beneficial property of the agent. Peri-operative use of dexmedetomidine also decreases postoperative opioid consumption, pain intensity, and antiemetic therapy. However, the data related to the effects of dexmedetomidine on reducing agitation from general anesthesia in adults are limited.
Read the detailed description
With no premedication, all patients will have pre-oxygenation for 3-5 minutes and intravenous access will be secured. NaCl 0.9% 4 ml/kg/h will be infused intraoperatively. General anesthesia will be induced by fentanyl 1 ug/kg, propofol 2 mg/kg and nimbex (cisatracurium) 0.15 mg/kg. Endotracheal intubation then will be done using oral ETT of appropriate size under direct laryngoscopy and secured at the angle of the mouth. Sevoflurane inhalational anesthetic (2-4 %) and nimbex 0.03 mg/kg will be used for maintenance of anesthesia. The lungs will be mechanically ventilated to keep intra-operative EtCo2 between 35-40 mmHg.
Intraoperative monitoring:
Routine monitors including ECG, non-invasive blood pressure, pulse oxymetry and EtCo2 will be recorded every 5 minutes during the intra-operative 20 minutes of the study drug administration. Bradycadia (heart rate ˂ 60 beat/minute) will be treated with iv atropine 0.5 mg. Hypotension (mean arterial blood pressure ˂ 60 mmHg) will be treated with iv ephedrine 5 mg increments. Duration of anesthesia, sevoflurane % and duration of surgery will be recorded.
At the end of surgery and stoppage of sevoflurane inhalation, neostigmine 0.04 mg/kg and atropine 0.02 mg/kg will be used for muscle relaxant reversal (Time 0 in the emergence process), patients will be extubated and transferred to the PACU for recovery and monitoring.
Assessment in PACU:
Routine monitoring will be continued during staying in PACU. During emergence, the level of agitation will be evaluated using the Ricker sedation-agitation scale (RSAS). The maximum level of agitation will be recorded for each patient at time 0, 5, 10, 20, 30, 60 and 120 minutes. Emergence agitation was defined as any score on the sedation-agitation scale ≥ 5. Dangerous agitation was defined as a sedation-agitation scale score = 7 (3). If dangerous agitation occurs, it will be treated with fentanyl 1 ug/kg.
Duration of stay in PACU will be recorded. Criteria for discharge from PACU will be applied according to the modified Aldrete scoring system. A score ≥ 9 was required for discharge.
Postoperative Analgesia:
The 10 points Visual Analogue Scale (VAS) for pain measurement will be used to assess the severity of postoperative pain. Score 0 indicates no pain and score 10 indicates severe pain. If VAS ≥ 4, rescue analgesia will be indicated. Perfalgan infusion will be used as supplemental analgesia. The first dose and the total amount in 24 hours of perfalgan will be recorded. Patient's satisfaction will be recorded at the end of the first 24 hours postoperatively.
Blood Sampling:
Venous blood samples will be collected from peripheral extremities away from the intravenous infused limb. Samples will be withdrawn 30 minutes pre-operatively, 30 minutes after skin incision, 2 and 24 hours after end of surgery. The blood samples will be centrifuged at 3500 ×g for at least 10 minutes and then serum samples will be eluted. Blood glucose level will be also recorded at the same times.
Statistical Analysis:
Statistical analysis will be conducted with SPSS version 20 (SPSS Inc., Chicago, IL, USA) for Windows. The results will be expressed as mean ± SD, range, percentage. P-values < 0.05 will be considered statistically significant.
- Conditions
- Stress Response
- Being tested
- Dexmedetomidine
- Keywords
- Dexmedetomidine, Stress response, Emergence agitation
- Medical subject headings
- Fractures, Stress, Emergence Delirium
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
DexmedetomidineDrug
Group I will receive 1 ug/kg, group II will receive 0.75 ug/kg and group III will receive 0.5 ug/kg) diluted to 50 ml NaCl 0.9% by syringe pump over 20 minutes before end of surgery.
| Study group | Role | What they receive |
|---|---|---|
| Dexmedetomidine 1 | Active comparator | patients will receive dexmedetomidine 1 mic/kg Receives: Drug: Dexmedetomidine |
| Dexmedetomidine 0.75 | Active comparator | patients will receive dexmedetomidine 0.75 mic/kg Receives: Drug: Dexmedetomidine |
| Dexmedetomidine 0.5 | Active comparator | patients will receive dexmedetomidine 0.5 mic/kg Receives: Drug: Dexmedetomidine |
What is being measured
The primary outcome is the main question the study is designed to answer.
serum cortisol level
serum cortisol level will be measured at 2 hours postoperative
Measured: 2 hours postoperative
Secondary outcomes (2)
post anesthetic emergence agitation
RSAS score will be measured 2 hours postoperative
Measured: 2 hours postoperative
visual analogue score
perfalgan will be given when visual analogue score ≥ 4
Measured: 24 hours postoperative
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Sep 2016 (estimated)
- Study startMay 2016
- Primary completionDec 2016
- Study completionDec 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Stress ResponseStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 2/3
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Care provider
- Enrolment
- 90 participants (actual)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, MOHAMED F. MOSTAFA, Assiut University
- Investigators
- Hamdy Yossef, MD, Study chair, assiut university, faculty of medicine
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02917018
- Sponsor's protocol ID
- Dexmed EA
- Status last verified
- Jan 2017
- First submitted
- 5 Sep 2016
- Last updated
- 4 Jan 2017
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 4 Jan 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Different Doses of Dexmedetomidine on Stress Response and Emergence Agitation After Laparoscopic Cholecystectomy in Adults
- ClinicalTrials.gov ID
- NCT02917018
- Acronym / sponsor ID
- Dexmed EA
- Conditions
- Stress Response
- Keywords
- Dexmedetomidine, Stress response, Emergence agitation
- Phase
- Phase 2/3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 90 participants (actual)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- May 2016
- Primary completion
- Dec 2016 (actual)
- Study completion
- Dec 2016 (actual)
- First posted
- 28 Sep 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Emergence agitation is a post-anesthetic phenomenon that develops in the early phase of general anesthesia recovery, and is characterized by agitation, confusion, disorientation, and possible violent behavior. The incidence of emergence agitation is less common in adults as compared to pediatric patients. It may lead to serious consequences for the patient such as bleeding, falling, removal of catheters and self extubation, which lead to further complications like hypoxia and aspiration.
Despite its common occurrence, unclear etiology, and serious sequelae, emergence agitation has rarely been studied in adults.
The stress response to surgery is an unconscious response to tissue injury. Activation of the sympathetic nervous system, increase of catabolic hormone release and pituitary gland suppression are considered a response to surgical stress, in clinical practice these activities cause changes in heart rate, blood pressure and biochemical fluctuations of noradrenaline, adrenaline, dopamine, and cortisol. Above all, these fluctuations prolong hospitalization and delay patients discharge.
Dexmedetomidine is a highly selective alpha-2 receptor agonist having sedative, analgesic and sympatholytic properties. Decreased stress response to surgery ensuring a stable hemodynamic state is a beneficial property of the agent. Peri-operative use of dexmedetomidine also decreases postoperative opioid consumption, pain intensity, and antiemetic therapy. However, the data related to the effects of dexmedetomidine on reducing agitation from general anesthesia in adults are limited.
Detailed description
With no premedication, all patients will have pre-oxygenation for 3-5 minutes and intravenous access will be secured. NaCl 0.9% 4 ml/kg/h will be infused intraoperatively. General anesthesia will be induced by fentanyl 1 ug/kg, propofol 2 mg/kg and nimbex (cisatracurium) 0.15 mg/kg. Endotracheal intubation then will be done using oral ETT of appropriate size under direct laryngoscopy and secured at the angle of the mouth. Sevoflurane inhalational anesthetic (2-4 %) and nimbex 0.03 mg/kg will be used for maintenance of anesthesia. The lungs will be mechanically ventilated to keep intra-operative EtCo2 between 35-40 mmHg.
Intraoperative monitoring:
Routine monitors including ECG, non-invasive blood pressure, pulse oxymetry and EtCo2 will be recorded every 5 minutes during the intra-operative 20 minutes of the study drug administration. Bradycadia (heart rate ˂ 60 beat/minute) will be treated with iv atropine 0.5 mg. Hypotension (mean arterial blood pressure ˂ 60 mmHg) will be treated with iv ephedrine 5 mg increments. Duration of anesthesia, sevoflurane % and duration of surgery will be recorded.
At the end of surgery and stoppage of sevoflurane inhalation, neostigmine 0.04 mg/kg and atropine 0.02 mg/kg will be used for muscle relaxant reversal (Time 0 in the emergence process), patients will be extubated and transferred to the PACU for recovery and monitoring.
Assessment in PACU:
Routine monitoring will be continued during staying in PACU. During emergence, the level of agitation will be evaluated using the Ricker sedation-agitation scale (RSAS). The maximum level of agitation will be recorded for each patient at time 0, 5, 10, 20, 30, 60 and 120 minutes. Emergence agitation was defined as any score on the sedation-agitation scale ≥ 5. Dangerous agitation was defined as a sedation-agitation scale score = 7 (3). If dangerous agitation occurs, it will be treated with fentanyl 1 ug/kg.
Duration of stay in PACU will be recorded. Criteria for discharge from PACU will be applied according to the modified Aldrete scoring system. A score ≥ 9 was required for discharge.
Postoperative Analgesia:
The 10 points Visual Analogue Scale (VAS) for pain measurement will be used to assess the severity of postoperative pain. Score 0 indicates no pain and score 10 indicates severe pain. If VAS ≥ 4, rescue analgesia will be indicated. Perfalgan infusion will be used as supplemental analgesia. The first dose and the total amount in 24 hours of perfalgan will be recorded. Patient's satisfaction will be recorded at the end of the first 24 hours postoperatively.
Blood Sampling:
Venous blood samples will be collected from peripheral extremities away from the intravenous infused limb. Samples will be withdrawn 30 minutes pre-operatively, 30 minutes after skin incision, 2 and 24 hours after end of surgery. The blood samples will be centrifuged at 3500 ×g for at least 10 minutes and then serum samples will be eluted. Blood glucose level will be also recorded at the same times.
Statistical Analysis:
Statistical analysis will be conducted with SPSS version 20 (SPSS Inc., Chicago, IL, USA) for Windows. The results will be expressed as mean ± SD, range, percentage. P-values < 0.05 will be considered statistically significant.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, care provider)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Dexmedetomidine 1 | Active comparator | Drug: Dexmedetomidinepatients will receive dexmedetomidine 1 mic/kg |
| Dexmedetomidine 0.75 | Active comparator | Drug: Dexmedetomidinepatients will receive dexmedetomidine 0.75 mic/kg |
| Dexmedetomidine 0.5 | Active comparator | Drug: Dexmedetomidinepatients will receive dexmedetomidine 0.5 mic/kg |
Who may qualify
- Ages
- 20 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- ASA I - II Laparoscopic cholecystectomy under general anesthesia
Key exclusion criteria (1 listed)
- Patients with cardiac disease, diabetes. reactive upper airway disease. allergies to dexmedetomidine. cognitive disorders. renal insufficiency. hepatic dysfunction. Chronic use of analgesics, cortisone or drugs known to interact with dexmedetomidine.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| DexmedetomidineGroup I will receive 1 ug/kg, group II will receive 0.75 ug/kg and group III will receive 0.5 ug/kg) diluted to 50 ml NaCl 0.9% by syringe pump over 20 minutes before end of surgery. | Drug | Dexmedetomidine 0.5, Dexmedetomidine 0.75, Dexmedetomidine 1 |
Primary outcome
serum cortisol level
Time frame: 2 hours postoperative
serum cortisol level will be measured at 2 hours postoperative
2 secondary outcomes
post anesthetic emergence agitation
Time frame: 2 hours postoperative
visual analogue score
Time frame: 24 hours postoperative
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Jan 2017.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Hamdy Yossef, MD study chair
assiut university, faculty of medicine
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2/3 study testing Dexmedetomidine in people with Stress Response, run by Assiut University at 1 site in Egypt.
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 1 inclusion and 1 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 4 Jan 2017. 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 Egypt. 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 combined phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
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?
serum cortisol level (time frame: 2 hours postoperative). 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 4 Jan 2017.