HypospadiasEPIVANCT05936853
The EPigenetic Consequences in Children of Intravenous vs Volatile Anaesthesia for Surgery (EPIVA)
A study testing Intravenous approach to anaesthetic maintenance and Inhalational approach to anaesthetic maintenance in people with Hypospadias and Anesthesia; Adverse Effect, run by University Hospital Southampton NHS Foundation Trust at 1 site in United Kingdom.
Trial summary
More than half a million children have an anaesthetic each year in the UK. Though anaesthesia is usually thought to be safe and necessary to improve health, concerns remain the effects that the drugs used may have on brain development in children and the potential long-term consequences for health. Read more about this study
- Who is it for?
- Ages 6 months to 3 years, men only
- Conditions the study is for
- Hypospadias, Anesthesia; Adverse Effect, Perioperative Complication
- What is being tested?
- Intravenous approach to anaesthetic maintenance and Inhalational approach to anaesthetic maintenance
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 16 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- 3 Aug 2023to 30 Sep 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 6 months to 3 years
- Men only
- No healthy volunteers
- Child
Who may be able to join
- Age ≥6 months and ≤ 3 years at time of initial operation
- Undergoing hypospadias surgery
- Maintenance phase of anaesthesia for procedure has an estimated length of ≥1 hour (established through MDT discussion prior to surgery).
- Completed informed consent form (ICF) from legal representative (LR (this is the person who is empowered to give informed consent on behalf of a participant. For most children this will be one or both parents. This may also be a guardian or custodian with legal custody)).
Who cannot join
- LR unable to provide completed ICF
- Withdrawal of consent at any stage
- Previous exposure to general anaesthesia at any stage of life, including in-utero (through maternal exposure at any stage until delivery)
- Neurodevelopmental/neurodisability diagnosis (given or under investigation) from a paediatric service including autistic specturm disorder (ASD), attention deficit disorder (ADHD), traumatic brain injury (TBI), down's syndrome, cerebral palsy, epilepsy
- Known contraindication to either volatile-based inhalational anaesthesia or TIVA (surgery or participant)
- Clinician refusal
Trial locations and contacts
1 site in 1 country.
United Kingdom1 site
University Hospital Southampton
Southampton, Hampshire, SO16 6YD
About this study
Official title: The EPigenetic Consequences in Children of Intravenous vs Volatile Anaesthesia for Surgery (EPIVA) - A Randomised, Feasibility Trial
More than half a million children have an anaesthetic each year in the UK. Though anaesthesia is usually thought to be safe and necessary to improve health, concerns remain the effects that the drugs used may have on brain development in children and the potential long-term consequences for health. The two techniques used to keep someone asleep during anaesthesia are either giving the appropriate drugs through a small plastic tube into a vein or introducing different drugs into the lungs in gas form.
Gene expression is the process by which instructions in DNA are used to make products such as proteins. Anaesthetic drugs may change how a child's genes are expressed; a process called epigenetics. Studies have shown that different anaesthetic drugs can cause epigenetic changes in animals and affect the processing ability of their brains.
Read more
This study will focus on children aged under 3 undergoing general anaesthesia for planned hypospadias surgery (a developmental condition where the look and function of the penis may not be completely normally). Participants will either receive their general anaesthetic in gas form or through directly into their veins - both techniques are commonly used. A small blood sample (between 1 and 2 teaspoons) will be collected at the start and end of the operation whilst under anaesthetic. Samples will be analysed to look for any changes in signals on DNA (epigenetic changes) and other markers. Further analysis may then look at other measures of gene expression and additional processes/markers that could be affected.
There is relatively less medical research carried out in children and this work will show whether this type of study is possible in this age-group and provide information for future trials. It will help towards improving our understanding of the effects of anaesthesia ultimately help doctors and families make better informed decisions.
Read the detailed description
There remains uncertainty about the impact that general anaesthesia may have on many different processes and systems for a child. The effect on the developing brain is an area that has received growing attention over the last decade. Pre-clinical studies, including those looking at cells and animal models, have demonstrated the harmful effect that anaesthetic drugs can cause in nerve cells. Large studies of children have suggested that early age exposure to anaesthetic drugs may impact cognitive and behavioural outcomes however, although this has not been a universal finding.
In 2016 the United States Food and Drug Administration (FDA) issued a warning regarding the use of anaesthetic drugs for children aged under 3 years, with the highest level of concern afforded to those who have prolonged and/or repeat exposures, showing the importance of this topic. This importance is further highlighted by the annual paediatric anaesthetic caseload - more than half a million children have an anaesthetic each year in the UK. There have been pre-clinical studies that have suggested that the way in which anaesthetic drugs can impact on neurodevelopment and cognition is through modifying the way in which genes are expressed by altering signals on DNA (epigenetics). This research aims to explore whether these changes in signals in DNA (epigenetic changes) can be seen in children undergoing anaesthesia and whether this is impacted by the type of anaesthetic given.
To do this, the trial has been designed as a randomised, clinical, feasibility trial in which participants undergoing hypospadias surgery will be randomised to one of the two anaesthetic maintenance approaches that are used routinely in clinical practice: intravenous or inhalational. Baseline data, including demographics, will be collected. On the day of their surgery, participants will receive maintenance of anaesthesia either through inhalational anaesthesia or intravenous anaesthesia according to allocation at randomisation - participants and their legal representatives will be blinded to group allocation and subsequent analysis will be performed with blinding to allocation. The participant will then be anaesthetised, and a baseline blood sample will be taken from the cannula that is routinely inserted into a vein to give medication to the patient. If this is not possible, the sample will be taken from a peripheral site. After the surgical procedure is complete and before the participant wakes up from general anaesthesia, a second blood will be taken. Blood will then undergo laboratory analysis including epigenetic, biochemical, haematological, and redox.
This trial has been designed as a feasibility trial to evaluate whether a larger scale trial looking at anaesthesia and surgery in relation to changes in markers on DNA (epigenetics) is both possible, and of value. Currently there have been no published studies looking at whether general anaesthesia can cause epigenetic changes in children, and whether the type of anaesthetic given has an impact on any changes present. There is significantly less published research in children as it necessitates many additional considerations; this is part of the rationale for this study being designed as a feasibility trial with the primary objective of assessing and determining the feasibility of conducting a paediatric perioperative epigenetics study in which participants are randomised to two methods of maintaining anaesthesia for surgery. Alongside measures such as recruitment and retention rate, screening numbers, protocol compliance figures, this objective will incorporate feedback on acceptability for participants and clinical staff, the success of the data management system used, and if any additional resources are required.
It has also been designed to address the secondary objectives of exploring whether anaesthesia and surgery are associated with epigenetic changes in whole blood, whether the strategy used to maintain anaesthesia impacts any epigenetic changes observed, and to identify which genes, pathways, and functional biological processes, may potentially be involved.
Those with day-to-day responsibility for trial conduct will either be Good Clinical Practice trained trial-team members, or members of the treating clinical team. The Sponsor will continue to have oversight of the trial throughout, and their representatives will communicate closely with the trial team. The end of the study is defined as completion of the full set of analyses of the blood samples taken from participants. The findings will be disseminated in both a timely and responsible manner amongst the relevant scientific community and shared in an appropriate fashion with the legal representatives of the children who took part after. Reporting of the findings may take the form of presentations at meetings/conferences alongside the writing of a manuscript for submission to a scientific journal.
- Being tested
- Intravenous approach to anaesthetic maintenance, Inhalational approach to anaesthetic maintenance
- Keywords
- Total intravenous anaesthesia, TIVA, Volatile, Epigenetics, Trial, Surgery, Pediatric, Paediatric, General Anaesthesia
- Medical subject headings
- Hypospadias, Precursor Cell Lymphoblastic Leukemia-Lymphoma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Intravenous approach to anaesthetic maintenanceOther
Anaesthetic agents given directly into the bloodstream via a cannula.
Inhalational approach to anaesthetic maintenanceOther
Volatile-based anaesthetic drugs are breathed in and then absorbed into the bloodstream through the lungs.
| Study group | Role | What they receive |
|---|---|---|
| Total intravenous anaesthesia (TIVA) | Active comparator | This arm will receive maintenance of anaesthesia through a total intravenous anaesthesia approach (TIVA) Receives: Other: Intravenous approach to anaesthetic maintenance |
| Inhalational anaesthesia | Active comparator | This arm will receive maintenance of anaesthesia through an inhalational anaesthesia approach Receives: Other: Inhalational approach to anaesthetic maintenance |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of eligible patients screened
Total number of patients during period that would be eligible for the trial
Measured: 6 months
Recruitment rate
Number of participants randomised divided by the number screened
Measured: 6 months
Retention rate
Number of participants that complete the study divided by the number who start it
Measured: 6 months
Protocol compliance
Number of deviations from trial protocol for each patient
Measured: 6 months
Acceptability of trial process for the legal representatives of participants
Outcome to assess whether the legal representatives of participants found the process of partaking in the trial acceptable. This will be self-reported through feedback requests.
Measured: Up to 1 month
Acceptability of trial process for clinical staff
Outcome to assess whether the clinical staff involved in conducting the protocol found this acceptable. This will be self-reported through feedback requests.
Measured: Up to 6 months
Secondary outcomes (2)
Epigenetic changes in whole blood in those undergoing anaesthesia for hypospadias surgery
Changes in DNA methylation profile of whole blood (using Illumina Infinium MethylationEPIC BeadChip (850K)) between pre-surgery and post-surgery
Measured: 5 minutes after induction of anaesthesia, 5 minutes after completion of surgical procedure
Epigenetic changes in whole blood; comparing the two arms of the trial
Changes in DNA methylation profile of whole blood (using Illumina Infinium MethylationEPIC BeadChip (850K)) between the two trial arms (TIVA vs inhalational anaesthesia)
Measured: 5 minutes after induction of anaesthesia and 5 minutes after completion of surgical procedure
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Jul 2023
- Study start3 Aug 2023
- Primary completion23 Feb 2024
- Study completion30 Sep 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (15)Papers the sponsor has linked to this study.
- Other trials for HypospadiasStudies of the same condition, open and under way.
- 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 N/A
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be randomised to receive maintenance of anaesthesia through either an intravenous approach (TIVA) or inhalational approach (using volatile agents). As is routine anaesthetic practice for this age-group, a gas/inhalational induction will be performed for all participants. After induction a baseline sample of blood will be taken. For participants in the inhalational maintenance group the volatile-based anaesthetic agent (in an air and oxygen mixture) will be continued after induction for the duration of the case. For participants in the TIVA maintenance group, once induction of anaesthesia has been successfully completed, at the earliest appropriate opportunity, the volatile-based anaesthetic will be switched to TIVA which will then be continued for the duration of the case. After the surgical procedure has been completed, and prior to emergence from general anaesthesia, a further blood sample will be taken for analysis.
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 16 participants (actual)
Sponsor and investigators
- Lead sponsor
- University Hospital Southampton NHS Foundation Trust
- Sponsor type
- University, hospital or other
- Collaborators
- University of Southampton
- Responsible party
- Sponsor
- Investigators
- Joseph Larvin, BMBCH, Principal investigator, University Hospital Southampton and University of Southampton
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05936853
- Sponsor's protocol ID
- RHM CRI0434
- Acronym
- EPIVA
- Status last verified
- Jun 2025
- First submitted
- 20 Jun 2023
- Last updated
- 15 Jun 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: The datasets generated during and/or analysed during the current study will be available upon request, including the baseline characteristics of patients, feasibility results, and the results of the 850k microarray analysis. Any information is shared and data will remain anonymised at all stages. Age at time of recruitment in years and months will be provided as opposed to date of birth will not be. IPD forms part of the informed consent form
Publications
Vutskits L, Xie Z. Lasting impact of general anaesthesia on the brain: mechanisms and relevance. Nat Rev Neurosci. 2016 Oct 18;17(11):705-717. doi: 10.1038/nrn.2016.128.
PubMed 27752068Vutskits L, Davidson A. Update on developmental anesthesia neurotoxicity. Curr Opin Anaesthesiol. 2017 Jun;30(3):337-342. doi: 10.1097/ACO.0000000000000461.
PubMed 28277380Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, Olney JW, Wozniak DF. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003 Feb 1;23(3):876-82. doi: 10.1523/JNEUROSCI.23-03-00876.2003.
PubMed 12574416Brambrink AM, Back SA, Riddle A, Gong X, Moravec MD, Dissen GA, Creeley CE, Dikranian KT, Olney JW. Isoflurane-induced apoptosis of oligodendrocytes in the neonatal primate brain. Ann Neurol. 2012 Oct;72(4):525-35. doi: 10.1002/ana.23652.
PubMed 23109147DiMaggio C, Sun LS, Kakavouli A, Byrne MW, Li G. A retrospective cohort study of the association of anesthesia and hernia repair surgery with behavioral and developmental disorders in young children. J Neurosurg Anesthesiol. 2009 Oct;21(4):286-91. doi: 10.1097/ANA.0b013e3181a71f11.
PubMed 19955889Ing C, DiMaggio C, Whitehouse A, Hegarty MK, Brady J, von Ungern-Sternberg BS, Davidson A, Wood AJ, Li G, Sun LS. Long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics. 2012 Sep;130(3):e476-85. doi: 10.1542/peds.2011-3822. Epub 2012 Aug 20.
PubMed 22908104Hu D, Flick RP, Zaccariello MJ, Colligan RC, Katusic SK, Schroeder DR, Hanson AC, Buenvenida SL, Gleich SJ, Wilder RT, Sprung J, Warner DO. Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort. Anesthesiology. 2017 Aug;127(2):227-240. doi: 10.1097/ALN.0000000000001735.
PubMed 28609302Warner DO, Zaccariello MJ, Katusic SK, Schroeder DR, Hanson AC, Schulte PJ, Buenvenida SL, Gleich SJ, Wilder RT, Sprung J, Hu D, Voigt RG, Paule MG, Chelonis JJ, Flick RP. Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study. Anesthesiology. 2018 Jul;129(1):89-105. doi: 10.1097/ALN.0000000000002232.
PubMed 29672337Ko WR, Huang JY, Chiang YC, Nfor ON, Ko PC, Jan SR, Lung CC, Chang HC, Lin LY, Liaw YP. Risk of autistic disorder after exposure to general anaesthesia and surgery: a nationwide, retrospective matched cohort study. Eur J Anaesthesiol. 2015 May;32(5):303-10. doi: 10.1097/EJA.0000000000000130.
PubMed 25101714Sun LS, Li G, Miller TL, Salorio C, Byrne MW, Bellinger DC, Ing C, Park R, Radcliffe J, Hays SR, DiMaggio CJ, Cooper TJ, Rauh V, Maxwell LG, Youn A, McGowan FX. Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. JAMA. 2016 Jun 7;315(21):2312-20. doi: 10.1001/jama.2016.6967.
PubMed 27272582Sury MR, Palmer JH, Cook TM, Pandit JJ. The state of UK anaesthesia: a survey of National Health Service activity in 2013. Br J Anaesth. 2014 Oct;113(4):575-84. doi: 10.1093/bja/aeu292. Epub 2014 Aug 7.
PubMed 25236896Milanovic D, Pesic V, Loncarevic-Vasiljkovic N, Avramovic V, Tesic V, Jevtovic-Todorovic V, Kanazir S, Ruzdijic S. Neonatal Propofol Anesthesia Changes Expression of Synaptic Plasticity Proteins and Increases Stereotypic and Anxyolitic Behavior in Adult Rats. Neurotox Res. 2017 Aug;32(2):247-263. doi: 10.1007/s12640-017-9730-0. Epub 2017 Apr 24.
PubMed 28435999Holtkamp C, Koos B, Unterberg M, Rahmel T, Bergmann L, Bazzi Z, Bazzi M, Bukhari H, Adamzik M, Rump K. A novel understanding of postoperative complications: In vitro study of the impact of propofol on epigenetic modifications in cholinergic genes. PLoS One. 2019 May 29;14(5):e0217269. doi: 10.1371/journal.pone.0217269. eCollection 2019.
PubMed 31141559Bourgeois FT, Murthy S, Pinto C, Olson KL, Ioannidis JP, Mandl KD. Pediatric versus adult drug trials for conditions with high pediatric disease burden. Pediatrics. 2012 Aug;130(2):285-92. doi: 10.1542/peds.2012-0139. Epub 2012 Jul 23.
PubMed 22826574Joseph PD, Craig JC, Caldwell PH. Clinical trials in children. Br J Clin Pharmacol. 2015 Mar;79(3):357-69. doi: 10.1111/bcp.12305.
PubMed 24325152
Study at a glance
From the registry record, last updated by the sponsor on 15 Jun 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The EPigenetic Consequences in Children of Intravenous vs Volatile Anaesthesia for Surgery (EPIVA) - A Randomised, Feasibility Trial
- ClinicalTrials.gov ID
- NCT05936853
- Acronym / sponsor ID
- EPIVA / RHM CRI0434
- Keywords
- Total intravenous anaesthesia, TIVA, Volatile, Epigenetics, Trial, Surgery, Pediatric, Paediatric
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 16 participants (actual)
- Lead sponsor
- University Hospital Southampton NHS Foundation TrustUniversity, hospital or other
- Collaborators
- University of Southampton
- Study start
- 3 Aug 2023 (actual)
- Primary completion
- 23 Feb 2024 (actual)
- Study completion
- 30 Sep 2026 (estimated)
- First posted
- 10 Jul 2023 (actual)
- 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.
More than half a million children have an anaesthetic each year in the UK. Though anaesthesia is usually thought to be safe and necessary to improve health, concerns remain the effects that the drugs used may have on brain development in children and the potential long-term consequences for health. The two techniques used to keep someone asleep during anaesthesia are either giving the appropriate drugs through a small plastic tube into a vein or introducing different drugs into the lungs in gas form.
Gene expression is the process by which instructions in DNA are used to make products such as proteins. Anaesthetic drugs may change how a child's genes are expressed; a process called epigenetics. Studies have shown that different anaesthetic drugs can cause epigenetic changes in animals and affect the processing ability of their brains.
This study will focus on children aged under 3 undergoing general anaesthesia for planned hypospadias surgery (a developmental condition where the look and function of the penis may not be completely normally). Participants will either receive their general anaesthetic in gas form or through directly into their veins - both techniques are commonly used. A small blood sample (between 1 and 2 teaspoons) will be collected at the start and end of the operation whilst under anaesthetic. Samples will be analysed to look for any changes in signals on DNA (epigenetic changes) and other markers. Further analysis may then look at other measures of gene expression and additional processes/markers that could be affected.
There is relatively less medical research carried out in children and this work will show whether this type of study is possible in this age-group and provide information for future trials. It will help towards improving our understanding of the effects of anaesthesia ultimately help doctors and families make better informed decisions.
Detailed description
There remains uncertainty about the impact that general anaesthesia may have on many different processes and systems for a child. The effect on the developing brain is an area that has received growing attention over the last decade. Pre-clinical studies, including those looking at cells and animal models, have demonstrated the harmful effect that anaesthetic drugs can cause in nerve cells. Large studies of children have suggested that early age exposure to anaesthetic drugs may impact cognitive and behavioural outcomes however, although this has not been a universal finding.
In 2016 the United States Food and Drug Administration (FDA) issued a warning regarding the use of anaesthetic drugs for children aged under 3 years, with the highest level of concern afforded to those who have prolonged and/or repeat exposures, showing the importance of this topic. This importance is further highlighted by the annual paediatric anaesthetic caseload - more than half a million children have an anaesthetic each year in the UK. There have been pre-clinical studies that have suggested that the way in which anaesthetic drugs can impact on neurodevelopment and cognition is through modifying the way in which genes are expressed by altering signals on DNA (epigenetics). This research aims to explore whether these changes in signals in DNA (epigenetic changes) can be seen in children undergoing anaesthesia and whether this is impacted by the type of anaesthetic given.
To do this, the trial has been designed as a randomised, clinical, feasibility trial in which participants undergoing hypospadias surgery will be randomised to one of the two anaesthetic maintenance approaches that are used routinely in clinical practice: intravenous or inhalational. Baseline data, including demographics, will be collected. On the day of their surgery, participants will receive maintenance of anaesthesia either through inhalational anaesthesia or intravenous anaesthesia according to allocation at randomisation - participants and their legal representatives will be blinded to group allocation and subsequent analysis will be performed with blinding to allocation. The participant will then be anaesthetised, and a baseline blood sample will be taken from the cannula that is routinely inserted into a vein to give medication to the patient. If this is not possible, the sample will be taken from a peripheral site. After the surgical procedure is complete and before the participant wakes up from general anaesthesia, a second blood will be taken. Blood will then undergo laboratory analysis including epigenetic, biochemical, haematological, and redox.
This trial has been designed as a feasibility trial to evaluate whether a larger scale trial looking at anaesthesia and surgery in relation to changes in markers on DNA (epigenetics) is both possible, and of value. Currently there have been no published studies looking at whether general anaesthesia can cause epigenetic changes in children, and whether the type of anaesthetic given has an impact on any changes present. There is significantly less published research in children as it necessitates many additional considerations; this is part of the rationale for this study being designed as a feasibility trial with the primary objective of assessing and determining the feasibility of conducting a paediatric perioperative epigenetics study in which participants are randomised to two methods of maintaining anaesthesia for surgery. Alongside measures such as recruitment and retention rate, screening numbers, protocol compliance figures, this objective will incorporate feedback on acceptability for participants and clinical staff, the success of the data management system used, and if any additional resources are required.
It has also been designed to address the secondary objectives of exploring whether anaesthesia and surgery are associated with epigenetic changes in whole blood, whether the strategy used to maintain anaesthesia impacts any epigenetic changes observed, and to identify which genes, pathways, and functional biological processes, may potentially be involved.
Those with day-to-day responsibility for trial conduct will either be Good Clinical Practice trained trial-team members, or members of the treating clinical team. The Sponsor will continue to have oversight of the trial throughout, and their representatives will communicate closely with the trial team. The end of the study is defined as completion of the full set of analyses of the blood samples taken from participants. The findings will be disseminated in both a timely and responsible manner amongst the relevant scientific community and shared in an appropriate fashion with the legal representatives of the children who took part after. Reporting of the findings may take the form of presentations at meetings/conferences alongside the writing of a manuscript for submission to a scientific journal.
Study design
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
- Model description
- Participants will be randomised to receive maintenance of anaesthesia through either an intravenous approach (TIVA) or inhalational approach (using volatile agents). As is routine anaesthetic practice for this age-group, a gas/inhalational induction will be performed for all participants. After induction a baseline sample of blood will be taken. For participants in the inhalational maintenance group the volatile-based anaesthetic agent (in an air and oxygen mixture) will be continued after induction for the duration of the case. For participants in the TIVA maintenance group, once induction of anaesthesia has been successfully completed, at the earliest appropriate opportunity, the volatile-based anaesthetic will be switched to TIVA which will then be continued for the duration of the case. After the surgical procedure has been completed, and prior to emergence from general anaesthesia, a further blood sample will be taken for analysis.
| Arm | Type | Receives |
|---|---|---|
| Total intravenous anaesthesia (TIVA) | Active comparator | Other: Intravenous approach to anaesthetic maintenanceThis arm will receive maintenance of anaesthesia through a total intravenous anaesthesia approach (TIVA) |
| Inhalational anaesthesia | Active comparator | Other: Inhalational approach to anaesthetic maintenanceThis arm will receive maintenance of anaesthesia through an inhalational anaesthesia approach |
Who may qualify
- Ages
- 6 months to 3 years
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (4 listed)
- Age ≥6 months and ≤ 3 years at time of initial operation
- Undergoing hypospadias surgery
- Maintenance phase of anaesthesia for procedure has an estimated length of ≥1 hour (established through MDT discussion prior to surgery).
- Completed informed consent form (ICF) from legal representative (LR (this is the person who is empowered to give informed consent on behalf of a participant. For most children this will be one or both parents. This may also be a guardian or custodian with legal custody)).
Key exclusion criteria (6 listed)
- LR unable to provide completed ICF
- Withdrawal of consent at any stage
- Previous exposure to general anaesthesia at any stage of life, including in-utero (through maternal exposure at any stage until delivery)
- Neurodevelopmental/neurodisability diagnosis (given or under investigation) from a paediatric service including autistic specturm disorder (ASD), attention deficit disorder (ADHD), traumatic brain injury (TBI), down's syndrome, cerebral palsy, epilepsy
- Known contraindication to either volatile-based inhalational anaesthesia or TIVA (surgery or participant)
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 |
|---|---|---|
| Intravenous approach to anaesthetic maintenanceAnaesthetic agents given directly into the bloodstream via a cannula. | Other | Total intravenous anaesthesia (TIVA) |
| Inhalational approach to anaesthetic maintenanceVolatile-based anaesthetic drugs are breathed in and then absorbed into the bloodstream through the lungs. | Other | Inhalational anaesthesia |
Primary outcome
Number of eligible patients screened
Time frame: 6 months
Total number of patients during period that would be eligible for the trial
Recruitment rate
Time frame: 6 months
Number of participants randomised divided by the number screened
Retention rate
Time frame: 6 months
Number of participants that complete the study divided by the number who start it
Protocol compliance
Time frame: 6 months
Number of deviations from trial protocol for each patient
Acceptability of trial process for the legal representatives of participants
Time frame: Up to 1 month
Outcome to assess whether the legal representatives of participants found the process of partaking in the trial acceptable. This will be self-reported through feedback requests.
Acceptability of trial process for clinical staff
Time frame: Up to 6 months
Outcome to assess whether the clinical staff involved in conducting the protocol found this acceptable. This will be self-reported through feedback requests.
2 secondary outcomes
Epigenetic changes in whole blood in those undergoing anaesthesia for hypospadias surgery
Time frame: 5 minutes after induction of anaesthesia, 5 minutes after completion of surgical procedure
Epigenetic changes in whole blood; comparing the two arms of the trial
Time frame: 5 minutes after induction of anaesthesia and 5 minutes after completion of surgical procedure
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Jun 2025.
- Background: PubMed 27752068Vutskits L, Xie Z. Lasting impact of general anaesthesia on the brain: mechanisms and relevance. Nat Rev Neurosci. 2016 Oct 18;17(11):705-717. doi: 10.1038/nrn.2016.128.
- Background: PubMed 28277380Vutskits L, Davidson A. Update on developmental anesthesia neurotoxicity. Curr Opin Anaesthesiol. 2017 Jun;30(3):337-342. doi: 10.1097/ACO.0000000000000461.
- Background: PubMed 12574416Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, Olney JW, Wozniak DF. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003 Feb 1;23(3):876-82. doi: 10.1523/JNEUROSCI.23-03-00876.2003.
- Background: PubMed 23109147Brambrink AM, Back SA, Riddle A, Gong X, Moravec MD, Dissen GA, Creeley CE, Dikranian KT, Olney JW. Isoflurane-induced apoptosis of oligodendrocytes in the neonatal primate brain. Ann Neurol. 2012 Oct;72(4):525-35. doi: 10.1002/ana.23652.
- Background: PubMed 19955889DiMaggio C, Sun LS, Kakavouli A, Byrne MW, Li G. A retrospective cohort study of the association of anesthesia and hernia repair surgery with behavioral and developmental disorders in young children. J Neurosurg Anesthesiol. 2009 Oct;21(4):286-91. doi: 10.1097/ANA.0b013e3181a71f11.
- Background: PubMed 22908104Ing C, DiMaggio C, Whitehouse A, Hegarty MK, Brady J, von Ungern-Sternberg BS, Davidson A, Wood AJ, Li G, Sun LS. Long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics. 2012 Sep;130(3):e476-85. doi: 10.1542/peds.2011-3822. Epub 2012 Aug 20.
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- Individual participant dataSharing planned: Yes. The datasets generated during and/or analysed during the current study will be available upon request, including the baseline characteristics of patients, feasibility results, and the results of the 850k microarray analysis. Any information is shared and data will remain anonymised at all stages. Age at time of recruitment in years and months will be provided as opposed to date of birth will not be. IPD forms part of the informed consent form
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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.
Joseph Larvin, BMBCH principal investigator
University Hospital Southampton and University of Southampton
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Intravenous approach to anaesthetic maintenance and Inhalational approach to anaesthetic maintenance in people with Hypospadias and Anesthesia; Adverse Effect, run by University Hospital Southampton NHS Foundation Trust at 1 site in United Kingdom.
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 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: under way, not looking for participants, as of the sponsor's last update on 15 Jun 2025. 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 United Kingdom. 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?
This study is still under way. Results are not available in the source record yet.
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?
Number of eligible patients screened (time frame: 6 months). The study lists 6 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 NCT05936853, which also lists 15 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 Jun 2025.