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Conscious Sedation Failure During ProcedureNCT05115578

Remifentanil Effect-site Prediction by Algometry

An observational study of Conscious Sedation Failure During Procedure, run by Hospital Universitari Vall d'Hebron Research Institute at 1 site in Spain.

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

This study validates the pharmacodynamic analgesic predictions (effect) given by Minto's remifentanil pharmacokinetic and dynamic model in conscious sedation. This standard model is based on the electroencephalogram (EEG) changes induced by this opioid as a proxy for describing the remifentanil analgesic effect, which… Read more about this study

Who is it for?
Ages 18 to 80 years, women onlyHealthy volunteers can take part
What is being tested?
Remifentanil 1 MG Injection [Ultiva], Midazolam 1 MG/ML Prefilled Syringe and Saline solution
How many people
100 participants
Where
1 siteSpain
Study dates
1 Mar 2017to 30 Sep 2020
Phase
Observational
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 80 years
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: We enrolled 100 female patients scheduled for benign gynaecological surgery. A group of 35 patients received a constant TCI effect-site target infusion of 1.5 ng/ml of remifentanil for 25 min. The second group of 35 followed the same protocol with a bolus of 1 mg of midazolam previous to the remifentanil infusion to evaluate potential anxiolysis effects. The rest configured to the control group. Algometry was used to quantify pressure pain thresholds regarding basal measurements at time-points of 1.5, 5, 10, 15, 18, 20, and 25 min after induction began beside the blood pressure and heart rate.

Who may be able to join

  • Female patients scheduled for benign gynaecological surgery
  • 18-80 years old
  • ASA I-III

Who cannot join

  • Morbid obesity
  • Conduct disorder or anxiety-depressive syndrome
  • Chronic treatment with psychotropic drugs or opiates
  • Pregnancy
  • Alcohol abuse
  • Documented allergy to remifentanil or midazolam
  • Refusal to participate in the study

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Ana Abad-Torrent

    Barcelona, 08035

Other trials in Spain

About this study

Official title: Remifentanil Pharmacodynamics During Conscious Sedation From the Algometry Perspective. An Essential Standpoint to be Considered in Opioids Time-course Modelling Validation

This study validates the pharmacodynamic analgesic predictions (effect) given by Minto's remifentanil pharmacokinetic and dynamic model in conscious sedation. This standard model is based on the electroencephalogram (EEG) changes induced by this opioid as a proxy for describing the remifentanil analgesic effect, which might be only valid for high concentrations. Validation of the standard remifentanil model for low concentrations under sedation is needed for safer remifentanil administration.

Read the detailed description

According to pharmacokinetic and-dynamic (PK/PD) models, the proper use of anesthetics depends on the effect-sites mechanisms and the time-courses of action. This aspect is crucial for the practitioners to target the desired effect-site concentrations of the drugs (drug concentration at brain) by optimizing the drug administration using target control infusion (TCI) systems operating under these model predictions.

For more than two decades, the pharmacodynamic properties of remifentanil relied on Minto's model, which is based on processed EEG as the reference to quantify the analgesic effect and effect-site concentration estimate. This remifentanil pharmacodynamic was modeled under conditions administered to volunteers rapidly and at very high doses to induce substantial changes in the spontaneous processed EEG. The experimental concentrations and infusion rates are far from sedative levels, where the EEG has shown a clear response to hypnosis but not to analgesia or nociception.

Under the hypothesis that pharmacological models should predict equally well the effects induced by drugs at different concentrations levels, the purpose of this study is to evaluate and validate the pharmacodynamic predictions given by Minto's model in patients under conscious sedation using the algometry as a reference of nociception.

The study recruits 100 female patients scheduled for benign gynecological surgery divided into three groups. A group of 35 patients receives a constant TCI effect-site target infusion of 1.5 ng/ml of remifentanil for 25 min. The second group of 35 follow the same protocol with a bolus of 1 mg of midazolam before the remifentanil infusion. The rest configures the control group under saline solution.

Experimental data consist of basal algometry (pressure pain threshold) aside from BIS index, blood pressure, and heart rate values and at time-points of 1.5, 5, 10, 15, 18, 20, and 25 minutes after induction.

Minto's remifentanil pharmacodynamic model validation relies on comparing the levels and temporal evolution of the algometry measurements during the whole experiment concerning the effect-site estimations provided by the TCI-pump Minto's model.

Being tested
Remifentanil 1 MG Injection [Ultiva], Midazolam 1 MG/ML Prefilled Syringe, Saline solution, Algometry
Keywords
Remifentanil, Algometry, Pharmacodynamics, TCI Infusion system, Conscious Sedation

What participants receive

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

  • Remifentanil 1 MG Injection [Ultiva]Drug

    Also called Opioid

    Group I TCI effect-site target infusion of 1.5 ng/ml of remifentanil.

  • Midazolam 1 MG/ML Prefilled SyringeDrug

    Also called Benzodiazepine

    Group II TCI effect-site target infusion of 1.5 ng/ml of remifentanil + 1 mg Midazolam iv

  • Saline solutionDrug

    Also called 0.9% Sodium Chloride Injection

    Group III Control

  • AlgometryDevice

    Also called Somedic Type II®, Sweden

    The algometry technique is used to assess the pain pressure threshold as an analgesic effect of remifentanil concerning Minto's model prediction.

Study groups in NCT05115578
Study groupRoleWhat they receive
Group I TCI effect-site target infusion of 1.5 ng/ml of remifentanilGroup I of 35 patients received a constant TCI effect-site target infusion of 1.5 ng/ml of remifentanil for 25 min.
Receives: Drug: Remifentanil 1 MG Injection [Ultiva]; Device: Algometry
Group II TCI effect-site target infusion of 1.5 ng/ml of remifentanil + 1 mg Midazolam ivGroup II of 35 patients received a constant TCI effect-site target infusion of 1.5 ng/ml of remifentanil for 25 min with a bolus of 1 mg of midazolam previous to the remifentanil infusion
Receives: Drug: Remifentanil 1 MG Injection [Ultiva]; Drug: Midazolam 1 MG/ML Prefilled Syringe; Device: Algometry
Group III ControlGroup III of 30 patients. The same TCI system provided the saline solution in the control group under an equivalent simulation profile to the remifentanil administration
Receives: Drug: Saline solution; Device: Algometry

What is being measured

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

  1. Pressure pain threshold (PPT) Baseline

    Measurement of pressure pain threshold (0 - 1.000 kPa) by algometry before starting the administration of remifentanil.

    Measured: Baseline

  2. Pressure pain threshold (PPT) 1.5 minutes

    Measurement of pressure pain threshold (0 - 1.000 kPa) by algometry 1.5 minutes after starting the administration of remifentanil.

    Measured: 1.5 minutes

  3. Pressure pain threshold (PPT) 5 minutes

    Measurement of pressure pain threshold (0 - 1.000 kPa) by algometry 5 minutes after starting the administration of remifentanil.

    Measured: 5 minutes

  4. Pressure pain threshold (PPT) 10 minutes

    Measurement of pressure pain threshold (0 - 1.000 kPa) by algometry 10 minutes after starting the administration of remifentanil.

    Measured: 10 minutes

  5. Pressure pain threshold (PPT) 15 minutes

    Measurement of pressure pain threshold(0 - 1.000 kPa) by algometry 15 minutes after starting the administration of remifentanil.

    Measured: 15 minutes

  6. Pressure pain threshold (PPT) 18 minutes

    Measurement of pressure pain threshold (0 - 1.000 kPa) by algometry 18 minutes after starting the administration of remifentanil.

    Measured: 18 minutes

  7. Pressure pain threshold (PPT) 20 minutes

    Measurement of pressure pain threshold (0 - 1.000 kPa) by algometry 20 minutes after starting the administration of remifentanil.

    Measured: 20 minutes

  8. Pressure pain threshold (PPT) 25 minutes

    Measurement of pressure pain threshold (0 - 1.000 kPa) by algometry 25 minutes after starting the administration of remifentanil.

    Measured: 25 minutes

  9. Infusion rate

    Remifentanil infusion rate (ml/h) administered during the experiment to the patient provided by the TCI system.

    Measured: Continous measurements every 1 second for the whole experiment of 25 minutes

  10. Remifentanil Plasma Concentration (Cp)

    Patient's remifentanil plasma concentration (ng/ml) evolution during the experiment given by Minto's model implemented in the TCI system.

    Measured: Continous measurements every 1 second for the whole experiment of 25 minutes

  11. Remifentanil Effect Concentration (Ce)

    Patient's remifentanil effect concentration (ng/ml) evolution during the experiment given by Minto's model implemented in the TCI system.

    Measured: Continous measurements every 1 second for the whole experiment of 25 minutes

Secondary outcomes (23)
  1. Age

    Apart from standard anthropometric data (Weight, Height, etc), age is of significant relevance for evaluating the possible effect of age on the pharmacodynamic properties of remifentanil and the algometry.

    Measured: Single annotation.

  2. Mean arterial pressure (MAP) Baseline

    Baseline mean arterial pressure (mmHg) from standard hemodynamic monitor.

    Measured: Baseline

  3. Mean arterial pressure (MAP) 1.5 min

    Measurement of mean arterial pressure (mmHg) 1.5 minutes after starting the administration of remifentanil.

    Measured: 1.5 minutes

  4. Mean arterial pressure (MAP) 5 min

    Measurement of mean arterial pressure (mmHg) 5 minutes after starting the administration of remifentanil.

    Measured: 5 minutes

  5. Mean arterial pressure (MAP) 10 min

    Measurement of mean arterial pressure (mmHg) 10 minutes after starting the administration of remifentanil.

    Measured: 10 minutes

  6. Mean arterial pressure (MAP) 15 min

    Measurement of mean arterial pressure (mmHg) 15 minutes after starting the administration of remifentanil.

    Measured: 15 minutes

  7. Mean arterial pressure (MAP) 18 min

    Measurement of mean arterial pressure (mmHg) 18 minutes after starting the administration of remifentanil.

    Measured: 18 minutes

  8. Mean arterial pressure (MAP) 20 min

    Measurement of mean arterial pressure (mmHg) 20 minutes after starting the administration of remifentanil.

    Measured: 20 minutes

  9. Mean arterial pressure (MAP) 25 min

    Measurement of mean arterial pressure (mmHg) 25 minutes after starting the administration of remifentanil.

    Measured: 25 minutes

  10. Heart Rate (HR) Baseline

    Baseline measurement of heart rate (beats/min)

    Measured: Baseline

  11. Heart Rate (HR) 1.5 min

    Measurement of heart rate (beats/min) 1.5 minutes after starting the administration of remifentanil.

    Measured: 1.5 minutes

  12. Heart Rate (HR) 5 min

    Measurement of heart rate (beats/min) 5 minutes after starting the administration of remifentanil.

    Measured: 5 minutes

  13. Heart Rate (HR) 10 min

    Measurement of heart rate (beats/min) 10 minutes after starting the administration of remifentanil.

    Measured: 10 minutes

  14. Heart Rate (HR) 15 min

    Measurement of heart rate (beats/min) 15 minutes after starting the administration of remifentanil.

    Measured: 15 minutes

  15. Heart Rate (HR) 18 min

    Measurement of heart rate (beats/min) 18 minutes after starting the administration of remifentanil.

    Measured: 18 minutes

  16. Heart Rate (HR) 20 min

    Measurement of heart rate (beats/min) 20 minutes after starting the administration of remifentanil.

    Measured: 20 minutes

  17. Bispectrum (BIS) Baseline

    Baseline measurement of EEG Bispectral index (adimensional index from 0- to 100).

    Measured: Baseline

  18. Bispectrum (BIS) 1.5 minutes

    EEG Bispectral index (adimensional index from 0- to 100) 1.5 minutes after starting the administration of remifentanil.

    Measured: 1.5 minutes

  19. Bispectrum (BIS) 5 minutes

    EEG Bispectral index (adimensional index from 0- to 100) 5 minutes after starting the administration of remifentanil.

    Measured: 5 minutes

  20. Bispectrum (BIS) 10 minutes

    EEG Bispectral index (adimensional index from 0- to 100) 10 minutes after starting the administration of remifentanil.

    Measured: 10 minutes

  21. Bispectrum (BIS) 15 minutes

    EEG Bispectral index (adimensional index from 0- to 100) 15 minutes after starting the administration of remifentanil.

    Measured: 15 minutes

  22. Bispectrum (BIS) 20 minutes

    EEG Bispectral index (adimensional index from 0- to 100) 20 minutes after starting the administration of remifentanil.

    Measured: 20 minutes

  23. Bispectrum (BIS) 25 minutes

    EEG Bispectral index (adimensional index from 0- to 100) 25 minutes after starting the administration of remifentanil.

    Measured: 25 minutes

Timeline

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

  1. First posted10 Nov 2021
  2. Study start1 Mar 2017
  3. Primary completion15 May 2020
  4. Study completion30 Sep 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
100 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05115578
Sponsor's protocol ID
EPA (AG) 33/2017 (5097)
Status last verified
Oct 2021
First submitted
15 Sep 2021
Last updated
10 Nov 2021
Results posted
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

An observational study of Conscious Sedation Failure During Procedure, run by Hospital Universitari Vall d'Hebron Research Institute at 1 site in Spain.

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 7 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 10 Nov 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 Spain. 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?

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?

Pressure pain threshold (PPT) Baseline (time frame: Baseline). The study lists 11 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 10 Nov 2021; AzTrials last refreshed its copy on 30 Oct 2026.

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