AzTrials
AzTrials

Head and Neck SurgeryNCT04963036

Impact of Nociception Level (NOL)-Guided Remifentanil Infusion on Intraoperative Arterial Pressure and Vasopressor Necessity

A study testing Entropy and NOL-Guided Goal Directed Anesthesia in people with Head and Neck Surgery and Maxillofacial Surgery, run by Centre Hospitalier Universitaire Saint Pierre 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 The sponsor has not verified this record for over two years, so it may be out of date.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
Search all trials

Trial summary

The aim of this study is to determine if Nociception Level (NOL)-guided Remifentanil analgesia, combined with Entropy-guided Propofol anesthesia, has a significant beneficial effect on the incidence of intraoperative hypotension episodes and/or on vasopressor requirements, during long-lasting major surgeries for high… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Head and Neck Surgery, Maxillofacial Surgery
What is being tested?
Entropy and NOL-Guided Goal Directed Anesthesia
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteBelgium
Study dates
28 Jul 2021to Jun 2022
Phase
Interventional
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥18
  • Elective high-risk head and neck or maxillo-facial surgery

Who cannot join

  • Patient refusal
  • Reduced ejection fraction below 40% and heart failure
  • History of atrial Fibrillation, pulmonary embolism, recent cardioversion, recent cardiac ischemic episode, chronic hypotension, chronic kidney insufficiency (serum creatinine > 1.5)
  • Septic state
  • Baseline heart-rate < 50 or > 90 bpm
  • History of psychiatric disease or medication

Trial locations and contacts

1 site in 1 country.

Panayota Kapessidou, MD,PhD contact

+32.2.535 ext. 3750

pkapessi@ulb.ac.be

Belgium1 site, 1 recruiting
  • CHU Saint-Pierre

    Brussels, 1000

    Panayota Kapessidou, MD,PhD, +32.2.535 ext. 3750, pkapessi@ulb.ac.be

    Medhi M'rini, MD, +32.2.535 ext. 3783, m.mrini@hotmail.com

    Recruiting

Other trials in Belgium

About this study

Official title: Impact of Nociception Level (NOL)-Guided Remifentanil Infusion and Entropy-guided Propofol Infusion on Intraoperative Arterial Pressure and Vasopressor Necessity A Prospective, Randomized, Controlled Trial.

The aim of this study is to determine if Nociception Level (NOL)-guided Remifentanil analgesia, combined with Entropy-guided Propofol anesthesia, has a significant beneficial effect on the incidence of intraoperative hypotension episodes and/or on vasopressor requirements, during long-lasting major surgeries for high risk patients. The investigator will also investigate the effects of guided anesthesia on postoperative Myocardial Injury in Non-cardiac Surgery (MINS) and Postoperative cognitive dysfunction (POCD), amongst other frequent postoperative complications, in this population.

Being tested
Entropy and NOL-Guided Goal Directed Anesthesia, Standard of Care Group (Entropy and blinded NOL)
Keywords
Nociception, Entropy, Analgesia, Goal Directed Anesthesia Therapy (GDAT), Remifentanil, Intraoperative Hypotension, Myocardial Injury in Non-Cardiac Surgery (MINS), Postoperative Cognitive Dysfunction (POCD)
Medical subject headings
Agnosia, Postoperative Cognitive Complications

What participants receive

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

  • Entropy and NOL-Guided Goal Directed AnesthesiaOther

    Entropy-guided Anesthesia (Propofol infusion in order to maintain Entropy between 45 and 55) and NOL-guided Analgesia (Remifentanil infusion in order to maintain NOL-Index between 10 and 25).

  • Standard of Care Group (Entropy and blinded NOL)Other

    Entropy-guided Anesthesia (Propofol infusion in order to obtain Entropy between 45 and 55) and Remifentanil infusion at the discretion of the anesthetist in charge, based on current practice: patient vitals (Heart Rate, Blood Pressure, Respiratory Rate…), movements, spontaneous breathing, experience....

    In this group, nociception monitor screen will be concealed and the NOL index will not be available for guidance of remifentanil dosing).

Study groups in NCT04963036
Study groupRoleWhat they receive
Entropy and NOL-Guided Goal Directed AnesthesiaExperimentalNot described
Receives: Other: Entropy and NOL-Guided Goal Directed Anesthesia
Standard of Care Group (Entropy and blinded NOL)Active comparatorNot described
Receives: Other: Standard of Care Group (Entropy and blinded NOL)

What is being measured

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

  1. Occurrence of intraoperative hypotension

    Occurrence of intraoperative hypotension is defined by at least 1 minute under the hypotension thresholds.

    Moderate and Severe Hypotension are respectively defined as a Mean Blood Pressure <65 mmHg or <55 mmHg and <75 or <65 mmHg for patient with history of chronic hypertension

    Measured: during surgery

  2. Total Vasopressor Dose

    Total Vasopressor Dose used throughout the intervention to maintain Arterial Pressure within a pre-defined individualized ranges (≥ 65 mmHg or ≥75 mmHg for patient with history of chronic hypertension, and ≤ 100 mmHg)

    Measured: during surgery

  3. Number of interventions to cure intraoperative hypotension

    Number of vasopressor boli or vasopressor infusion dose adjustments

    Measured: during surgery

  4. Total Time under hypotension thresholds

    Hypotension Thresholds ( <65 mmHg or < 75mmHg for patient with history of chronic hypertension)

    Measured: during surgery

Secondary outcomes (10)
  1. Myocardial Injury in Non-Cardiac Surgery (MINS) marker (Troponin T)

    Troponin T level measured before surgery, at end of surgery, 4 hours, 8 hours, 24 hours, 36 hours and 48 hours after surgery. The threshold is a postoperative concentration ≥ 20 ng/L with an increase from baseline of at least 5 ng/L, or a postoperative concentration ≥ 65 ng/L.

    Measured: up to 48 hours after surgery

  2. Postoperative Acute Kidney Injury (AKI) marker (creatinin/Glomerular Filtration Rate)

    Creatinin level measured before surgery, at end of surgery, 24 hours and 48 hours after surgery. The thresholds are defined by the Kidney Disease: Improving Global Outcomes (KDIGO) classification without the oliguria criteria.

    Measured: up to 48 hours after surgery

  3. Postoperative Cognitive Decline (POCD)

    POCD will be evaluated by cognitive dysfunction battery tests (written Montreal Cognitive Assessment (MOCA) Test) at days 5,10, 15, hospital discharge, 3 and 6 postoperative months

    Measured: up to 6 months after surgery

  4. PostOperative Delirium (PO Delirium)

    PO Delirium will be evaluated by the Confusion Assessment Method (CAM) at days 5, 10, 15, hospital discharge, 3 and 6 postoperative months

    Measured: up to 6 months after surgery

  5. Dosage of Stress Hormones

    Adrenocorticotropic Hormone (ACTH) and Cortisol will be measured in blood samples at the end of surgery, at the arrival in the ICU and at 4 hours after surgery.

    Measured: up to 4 hours after surgery

  6. Dosage of Neuro-Inflammatory Markers

    Interleukine-6 and Interleukine-8 will be measured in blood and saliva samples before surgery and during the postoperative period (4 hours, 24 hours and 48 hours after surgery).

    Measured: up to 48 hours after surgery

  7. Olfactory Function assessment as an indicator of Neuro-Inflammation

    A rapid quantitative olfactory function test, the University of Pennsylvania Smell Identification -Test (UPSIT-Test) will be performed before surgery and during the postoperative period (4 hours, 24 hours and 48 hours after surgery).

    Measured: up to 48 hours after surgery

  8. Length of Intensive Unit Care (IUC) stay

    Measured: up to 10 Days after surgery

  9. Length of hospital stay

    Measured: up to 15 Days after surgery

  10. Adverse Event (blood loss, infection)

    Measured: up to 15 Days after surgery

Timeline

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

  1. First posted15 Jul 2021
  2. Study start28 Jul 2021
  3. Primary completionJun 2022 (estimated)
  4. Study completionJun 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 N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04963036
Sponsor's protocol ID
B0762021210506
Status last verified
Jul 2021
First submitted
14 Jun 2021
Last updated
15 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Saugel B, Sessler DI. Perioperative Blood Pressure Management. Anesthesiology. 2021 Feb 1;134(2):250-261. doi: 10.1097/ALN.0000000000003610. No abstract available.

    PubMed 33206118
  • Sessler DI, Khanna AK. Perioperative myocardial injury and the contribution of hypotension. Intensive Care Med. 2018 Jun;44(6):811-822. doi: 10.1007/s00134-018-5224-7. Epub 2018 Jun 4.

    PubMed 29868971
  • Ruetzler K, Khanna AK, Sessler DI. Myocardial Injury After Noncardiac Surgery: Preoperative, Intraoperative, and Postoperative Aspects, Implications, and Directions. Anesth Analg. 2020 Jul;131(1):173-186. doi: 10.1213/ANE.0000000000004567.

    PubMed 31880630
  • Krzych LJ, Pluta MP, Putowski Z, Czok M. Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review. J Clin Med. 2020 Sep 30;9(10):3183. doi: 10.3390/jcm9103183.

    PubMed 33008109
  • Feng X, Hu J, Hua F, Zhang J, Zhang L, Xu G. The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2020 Aug 5;20(1):193. doi: 10.1186/s12871-020-01097-5.

    PubMed 32758153
  • Greaves D, Psaltis PJ, Davis DHJ, Ross TJ, Ghezzi ES, Lampit A, Smith AE, Keage HAD. Risk Factors for Delirium and Cognitive Decline Following Coronary Artery Bypass Grafting Surgery: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2020 Nov 17;9(22):e017275. doi: 10.1161/JAHA.120.017275. Epub 2020 Nov 7.

    PubMed 33164631
  • Belrose JC, Noppens RR. Anesthesiology and cognitive impairment: a narrative review of current clinical literature. BMC Anesthesiol. 2019 Dec 27;19(1):241. doi: 10.1186/s12871-019-0903-7.

    PubMed 31881996
  • Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013 Sep;119(3):507-15. doi: 10.1097/ALN.0b013e3182a10e26.

    PubMed 23835589
  • Evered LA, Silbert BS. Postoperative Cognitive Dysfunction and Noncardiac Surgery. Anesth Analg. 2018 Aug;127(2):496-505. doi: 10.1213/ANE.0000000000003514.

    PubMed 29889707
  • Ledowski T. Monitoring nociception-getting 'there yet' might be easier with a road map. Br J Anaesth. 2017 Oct 1;119(4):716-717. doi: 10.1093/bja/aex277. No abstract available.

    PubMed 29121306
  • Ledowski T. Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth. 2019 Aug;123(2):e312-e321. doi: 10.1016/j.bja.2019.03.024. Epub 2019 Apr 30.

    PubMed 31047645
  • De Jonckheere J, Bonhomme V, Jeanne M, Boselli E, Gruenewald M, Logier R, Richebe P. Physiological Signal Processing for Individualized Anti-nociception Management During General Anesthesia: a Review. Yearb Med Inform. 2015 Aug 13;10(1):95-101. doi: 10.15265/IY-2015-004.

    PubMed 26293855
  • Martini CH, Boon M, Broens SJ, Hekkelman EF, Oudhoff LA, Buddeke AW, Dahan A. Ability of the nociception level, a multiparameter composite of autonomic signals, to detect noxious stimuli during propofol-remifentanil anesthesia. Anesthesiology. 2015 Sep;123(3):524-34. doi: 10.1097/ALN.0000000000000757.

    PubMed 26154185
  • Meijer F, Honing M, Roor T, Toet S, Calis P, Olofsen E, Martini C, van Velzen M, Aarts L, Niesters M, Boon M, Dahan A. Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia: a randomised controlled trial. Br J Anaesth. 2020 Dec;125(6):1070-1078. doi: 10.1016/j.bja.2020.07.057. Epub 2020 Sep 17.

    PubMed 32950246
  • Futier E, Lefrant JY, Guinot PG, Godet T, Lorne E, Cuvillon P, Bertran S, Leone M, Pastene B, Piriou V, Molliex S, Albanese J, Julia JM, Tavernier B, Imhoff E, Bazin JE, Constantin JM, Pereira B, Jaber S; INPRESS Study Group. Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA. 2017 Oct 10;318(14):1346-1357. doi: 10.1001/jama.2017.14172.

    PubMed 28973220

Questions about this trial

What is this clinical trial studying?

A study testing Entropy and NOL-Guided Goal Directed Anesthesia in people with Head and Neck Surgery and Maxillofacial Surgery, run by Centre Hospitalier Universitaire Saint Pierre 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 2 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: status not confirmed, as of the sponsor's last update on 15 Apr 2022. 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.

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 Panayota Kapessidou, MD,PhD (+32.2.535 ext. 3750, pkapessi@ulb.ac.be), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Occurrence of intraoperative hypotension (time frame: during surgery). The study lists 4 primary outcomes in all. 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 NCT04963036, which also lists 19 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 15 Apr 2022.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in