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Perioperative AnxietyPhase 4NCT04273035

Handheld-multimedia Versus Oral Midazolam in Pediatric on Perioperative Anxiety

A Phase 4 study testing Midazolam oral solution and IPAD in people with Perioperative Anxiety and Preanesthetic Medication, run by Universitair Ziekenhuis Brussel at 1 site in Belgium.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The first goal of this study is to compare the efficacy and safety between anxiolysis by multimedia-distraction with an IPAD versus anxiolysis by premedication with midazolam prior to the induction. Read more about this study

Who is it for?
Ages 1 year to 8 years
What is being tested?
Midazolam oral solution and IPAD
Could I receive a placebo?
No, everyone receives an active treatment
How many people
150 participants
Where
1 siteBelgium
Study dates
1 Feb 2020to 28 Feb 2022
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 1 year to 8 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Age ≥ 1 year and <8 years old
  • ASA class 1 or 2 (American Society of Anesthesiologists Physical Status Classification System)
  • Elective circumcision, tonsillectomy or adenoidectomy, dental care procedure in day-care
  • Written informed consent by the legal parents or caretaker

Who cannot join

  • Parents of the patient wish not to participate with the study
  • Parents are not able to give informed consent (language barrier, legally incapable)
  • A contraindication for the use of premedication with midazolam
  • A known allergy to midazolam
  • A contraindication for premedication in general
  • A contraindication for the use of a gas-induction/gas-anesthesia
Show all 14Show fewer
  • A contraindication for the use of sevoflurane
  • A known mental retardation of the child
  • Preoperative behavioral disturbances and psychiatric disorders
  • Any use of psychoactive medication
  • A known photosensitive epilepsy
  • A previous operation within 3 months of the time of scheduled operation
  • Any other contraindication for the use of the study medication
  • Previous history of multiple surgery (>3)

Trial locations and contacts

1 site in 1 country.

Alex Van Hoorn, MD contact

+32468187852

Alex.VanHoorn@uzbrussel.be

Panagiotis Flamée, MD contact

+3224773143

Panagiotis.Flamee@uzbrussel.be

Belgium1 site, 1 recruiting
  • Universitair Ziekenhuis Brussel (UZ Brussel)

    Jette, 1090

    Alex Van Hoorn, MD, +324749232, Alex.VanHoorn@uzbrussel.be

    Pangiotis Flamée, MD, +324773143, Panagiotis.Flamee@uzbrussel.be

    Recruiting

Other trials in Belgium

About this study

Official title: The Effect of Handheld-multimedia Versus Oral Midazolam Preanesthetic on the Level of Perioperative Anxiety in Pediatric Day-care Surgery: A Randomized Controlled Trial

The first goal of this study is to compare the efficacy and safety between anxiolysis by multimedia-distraction with an IPAD versus anxiolysis by premedication with midazolam prior to the induction. Secondly to evaluate the need for midazolam-premedication in pediatric day-care patients induced by inhalational anesthesia.

Read the detailed description

Perioperative anxiety in children is a common multifactorial influenced and triggered entity with an incidence as high as 50%. Especially (mask)induction of anesthesia is considered one of the most stressful experiences for a child undergoing surgery. A common practice worldwide to diminish the level of anxiety prior to anesthesia is premedication with the benzodiazepine midazolam in order to improve cooperation during induction.

Premedication with midazolam has a primary purpose to reduce preoperative anxiety and has inherent to a benzodiazepine its sedative effects. Although these effects are implied, negative effects of premedication: respiratory complications, paradoxical negative behavior has been reported. Although alternative medications have been studied, studies for non-pharmacological anxiety-reduction remain limited.

Non-pharmacological anxiety-reduction by distraction including Tablet or IPAD-multimedia might be a readily available alternative for midazolam premedication. Potentially limiting the use of psychoactive agents, limiting the need for preoperative sedation and therefore possibly decrease secondary respiratory complications in pediatric surgical day-care.

Objective:

The first goal of this study is to compare the efficacy and safety between anxiolysis by multimedia-distraction with an IPAD versus anxiolysis by premedication with midazolam prior to the mask-induction of anesthesia. Secondly to evaluate the need for midazolam premedication in pediatric day-care surgery patients induced by inhalational anesthesia.

Being tested
Midazolam oral solution, IPAD
Keywords
Preanesthetic medication, Handheld computer, Midazolam, Multimedia, Anxiety, Mask induction, Day Care Surgery
Medical subject headings
Anxiety Disorders

What participants receive

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

  • Midazolam oral solutionDrug

    Also called Buccolam

    Oral Buccolam

  • IPADDevice

    Also called Handheld multimedia, tablet

    Playing any game, film, clip or puzzle on a tablet till after induction of anesthesia

Study groups in NCT04273035
Study groupRoleWhat they receive
Midazolam GroupActive comparator* Midazolam(Buccolam 5mg/ml) * 0.5mg/kg oral, max 12mg * one time * given 30 min prior to going to holding
Receives: Drug: Midazolam oral solution
IPAD groupActive comparator* No premedication * IPAD when arriving at the holding * any games, movies, clips, puzzles
Receives: Device: IPAD

What is being measured

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

  1. Anxiety level at induction

    Measured bij Short version modified Yale Preoperative Anxiety Scale(mYPAS-SF), scoring activity 1-4/4, vocalizations 1-6/6, emotional expressivity 1-4/4, state of apparent arousal 1-4/4, parental use 1-4/4, subtotal is the sum of all the individual scores divided by their number of choices, mYpas-SF total score is subtotal/5 * 100 and therefore a score between 23,3-100 Scored prior moment of mask induction (T2)

    Measured: Directly prior to induction of anesthesia, 20 minutes

  2. Anesthesiologist Satisfaction Induction

    Satisfactory Score for Induction/Anesthesia: 5 point scale: Very satisfactory, Satisfactory, Neutral, Unsatisfactory and Very satisfactory Scored in the OR directly post induction

    Measured: During induction of anesthesia 10 minutes

Secondary outcomes (26)
  1. Anxiety level at Daycare

    Measured bij Short version modified Yale Preoperative Anxiety Scale(mYPAS-SF), scoring activity 1-4/4, vocalizations 1-6/6, emotional expressivity 1-4/4, state of apparent arousal 1-4/4, parental use 1-4/4, subtotal is the sum of all the individual scores divided by their number of choices, mYpas-SF total score is subtotal/5 * 100 and therefore a score between 23,3-100 Scored at Daycare (T0) when leaving to holding

    Measured: Leaving daycare, 10 minutes

  2. Anxiety level at holding

    Measured bij Short version modified Yale Preoperative Anxiety Scale(mYPAS-SF), scoring activity 1-4/4, vocalizations 1-6/6, emotional expressivity 1-4/4, state of apparent arousal 1-4/4, parental use 1-4/4, subtotal is the sum of all the individual scores divided by their number of choices, mYpas-SF total score is subtotal/5 * 100 and therefore a score between 23,3-100 Scored at holding (T1) 10 minutes after arrival

    Measured: On holding, 20 minutes

  3. Anxiety level at recovery

    Measured bij Short version modified Yale Preoperative Anxiety Scale(mYPAS-SF), scoring activity 1-4/4, vocalizations 1-6/6, emotional expressivity 1-4/4, state of apparent arousal 1-4/4, parental use 1-4/4, subtotal is the sum of all the individual scores divided by their number of choices, mYpas-SF total score is subtotal/5 * 100 and therefore a score between 23,3-100 Scored at recovery (T3) 15 minutes after awake

    Measured: 15 minutes after awake, 30 minutes

  4. Anxiety level Change Daycare vs OR

    Measured bij Short version modified Yale Preoperative Anxiety Scale(mYPAS-SF), scoring activity 1-4/4, vocalizations 1-6/6, emotional expressivity 1-4/4, state of apparent arousal 1-4/4, parental use 1-4/4, subtotal is the sum of all the individual scores divided by their number of choices, mYpas-SF total score is subtotal/4 * 100 and therefore a score between 23,3-100

    Measured: change during daycare (T0) and induction(T2) in the OR, average 1 hour

  5. Sedation level at Daycare

    Richmond Agitation-Sedation Scale, RASS-score between -5 till + 4 Scored at Daycare (T0) when leaving to holding

    Measured: 10 minutes

  6. Sedation level at holding

    Richmond Agitation-Sedation Scale, RASS-score between -5 till + 4 Scored (T1) 10 minutes after arrival holding

    Measured: 20 minutes

  7. Sedation level at induction

    Richmond Agitation-Sedation Scale, RASS-score between -5 till + 4 Scored at moment of mask induction (T2)

    Measured: 10 minutes

  8. Sedation level at recovery

    Richmond Agitation-Sedation Scale, RASS-score between -5 till + 4 Scored 15 minutes after arrival recovery (T3)

    Measured: 30 minutes

  9. Laryngospasm at induction

    Laryngospasm by Four-point scale:

    1. No Laryngospasm
    2. Mild laryngospasm (relieved by jaw thrust and 100% oxygen),
    3. Moderate laryngospasm (relieved by 100% oxygen and positive pressure ventilation)
    4. Severe laryngospasm (relieved by succinylcholine and intubation) Scored in the OR post-induction

    Measured: 10 minutes

  10. Laryngospasm post extubation/post laryngeal mask

    Laryngospasm by Four-point scale:

    1. No Laryngospasm
    2. Mild laryngospasm (relieved by jaw thrust and 100% oxygen),
    3. Moderate laryngospasm (relieved by 100% oxygen and positive pressure ventilation)
    4. Severe laryngospasm (relieved by succinylcholine and intubation) Scored in the OR post detubation/post laryngeal mask

    Measured: 10 minutes

  11. Bronchospasm postinduction

    Bronchospasm/wheezing 1. Yes 2. No • In absence of scale Scored in the OR postinduction

    Measured: 10 minutes

  12. Bronchospasm post detubation/laryngeal mask

    Bronchospasm/wheezing 1. Yes 2. No • In absence of scale Scored in the OR post detonation/laryngeal mask

    Measured: 10 minutes

  13. Postoperative Pain

    The pain observation scale for young children (POCIS-Score) score 0-7, scoring 0 or1 for • face-expression: frowning/grimaces = 1, sound crying/moan =1, breathing: irregular/gasping/holding=1, body tonus: tense/shiver/restless =1, movement of arms: tense/fist/restless =1, movement of legs: tense/pulled up/flexed = 1, mood: agitation/restless = 1 Scored on the recovery 30 minutes after arrival

    Measured: 40 minutes

  14. Parental Satisfaction on the anxiety-management at daycare

    1. Very satisfied
    2. Satisfied
    3. Neutral
    4. Unsatisfactory
    5. Very Unsatisfactory Scored at daycare-surgery (T0)

    Measured: 10 minutes

  15. Parental Satisfaction on the anxiety-management at holding

    1. Very satisfied
    2. Satisfied
    3. Neutral
    4. Unsatisfactory
    5. Very Unsatisfactory Scored at holding (T1)

    Measured: 10 minutes

  16. Parental Satisfaction on the anxiety-management at OR

    1. Very satisfied
    2. Satisfied
    3. Neutral
    4. Unsatisfactory
    5. Very Unsatisfactory Scored after induction and parent has left the OR (T2)

    Measured: 10 minutes

  17. Parental Satisfaction on the anxiety-management at recovery

    1. Very satisfied
    2. Satisfied
    3. Neutral
    4. Unsatisfactory
    5. Very Unsatisfactory Scored at the recovery (T3)

    Measured: 10 minutes

  18. Parental Stress level at day care

    Parental Stress level in 5 - point scale- ´I feel':

    1. Extremely Stressed
    2. Very stressed
    3. moderate stressed
    4. Low stressed
    5. Very low stressed scored at day care (T0)

    Measured: 10 minutes

  19. Parental Stress level at holding

    Parental Stress level in 5 - point scale- ´I feel':

    1. Extremely Stressed
    2. Very stressed
    3. moderate stressed
    4. Low stressed
    5. Very low stressed Scored at holding (T1)

    Measured: 10 minutes

  20. Parental Stress level at OR

    Parental Stress level in 5 - point scale- ´I feel':

    1. Extremely Stressed
    2. Very stressed
    3. moderate stressed
    4. Low stressed
    5. Very low stressed Scored at OR (T2)

    Measured: 10 minutes

  21. Parental Stress level at recovery

    Parental Stress level in 5 - point scale- ´I feel':

    1. Extremely Stressed
    2. Very stressed
    3. moderate stressed
    4. Low stressed
    5. Very low stressed Scored at recovery (T3)

    Measured: 10 minutes

  22. Overall Parental Satisfaction

    5- Point scale

    1. Very satisfied
    2. Satisfied
    3. Neutral
    4. Unsatisfactory
    5. Very Unsatisfactory Scored when leaving recovery

    Measured: 10 minutes

  23. Child Stress level by parent at daycare

    Child Stress level by parent, 5- Point scale

    1. Happy, plays
    2. Slightly worried
    3. Worried, stops playing
    4. Fears, crying
    5. Hysterical Scored at daycare-surgery (T0)

    Measured: 10 minutes

  24. Child Stress level by parent at holding

    Child Stress level by parent, 5- Point scale

    1. Happy, plays
    2. Slightly worried
    3. Worried, stops playing
    4. Fears, crying
    5. Hysterical Scored at holding (T1)

    Measured: 10 minutes

  25. Child Stress level by parent at OR

    Child Stress level by parent, 5- Point scale

    1. happy, plays
    2. slightly worried
    3. worried, stops playing
    4. fear, crying
    5. hysterical Scored at OR after induction (T2)

    Measured: 10 minutes

  26. Child Stress level by parent at Recovery

    Child Stress level by parent, 5- Point scale

    1. Happy, plays
    2. Slightly worried
    3. Worried, stops playing
    4. Fear, crying
    5. Hysterical Scored at recovery (T3)

    Measured: 10 minutes

Timeline

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

  1. First posted17 Feb 2020
  2. Study start1 Feb 2020
  3. Primary completion31 Dec 2021 (estimated)
  4. Study completion28 Feb 2022 (estimated)

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
Model description
Group A: midazolam premedicated, standard of care Group B: IPAD, no midazolam premedication
Masking
None (open label)
Enrolment
150 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04273035
Sponsor's protocol ID
2019/318
Other IDs
2019-004671-39, 2019
Status last verified
Apr 2021
First submitted
5 Feb 2020
Last updated
4 May 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: * Individual participant data will be available after deidentification * For researchers who provide a methodological proposal * Achieving aims in the proposal * Proposals needs to be directed to the principal investigators

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Midazolam oral solution and IPAD in people with Perioperative Anxiety and Preanesthetic Medication, run by Universitair Ziekenhuis Brussel at 1 site in Belgium.

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 4 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: status not confirmed, as of the sponsor's last update on 4 May 2021. 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 Belgium. 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?

Results are not available in the source record.

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

Contact Alex Van Hoorn, MD (+32468187852, Alex.VanHoorn@uzbrussel.be), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Anxiety level at induction (time frame: Directly prior to induction of anesthesia, 20 minutes). The study lists 2 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 4 May 2021.

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