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Rapid Sequence InductionPhase 3HYPNOTIKSNCT06733129

Best Hypnotic Drug Choice for Rapid Sequence Induction in the Operating Room

A Phase 3 study testing direct IV injection and combination of Ketamine and Propofol in people with Rapid Sequence Induction, run by Nantes University Hospital at 20 sites in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The best hypnotic choice to optimize the balance between good intubation condition quality and hemodynamic stability during RSI performed in the operating theatre remained to be investigated. Therefore, a randomized study evaluating the efficacy of propofol, ketamine, and a combination of both is appropriate. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Rapid Sequence Induction
What is being tested?
direct IV injection and combination of Ketamine and Propofol
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,218 participants
Where
20 sitesFrance
Study dates
14 Apr 2025to 30 Apr 2027
Phase
Phase 3
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 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • age between 18 - 80 years' old
  • female* and male
  • ≥ 1 risk factor of aspiration of gastric contents defined as
  • preoperative fasting period of less than 6 hours,
  • occlusive syndrome, functional ileus, vomiting episode within the last 12 hours,
  • orthopaedic trauma within the last 12 hours,
Show all 10Show fewer
  • medical history of symptomatic gastroesophageal reflux or hiatus, hernia or gastroparesis or dysautonomia or gastroesophageal surgery with sphincter dysfunction)
  • patient requiring orotracheal intubation during general anaesthesia in the operating room.
  • patient or his/her next of kin written informed consent or emergency procedure
  • failure to discontinue GLP1 analogue as recommended (exenatide, liraglutide, albiglutide, taspoglutide, lixisenatide)

Who cannot join

  • predicted impossible tracheal intubation (≥ 1 of the following criteria: patient with known intubation complications, Mallampati score IV, Thyromental Distance ≤ 4.0 cm, Mouth Opening < 3 cm, Sternomental Distance < 12.5 cm, significant modification of the airway due to congenital, cancer, trauma or burning lesions (non-exhaustive list)) [30]
  • preoperative arterial hypotension (MAP < 65 mmHg or under catecholamine)
  • preoperative respiratory distress syndrome (SpO2 < 90% in room air)
  • contraindications to the use of ketamine and/or propofol and/or NMB:
  • allergy to the active substance or to one of the excipients or to soy or peanuts,
  • porphyria
Show all 12Show fewer
  • intracranial hypertension
  • uncontrolled arterial hypertension (systolic arterial pressure > 180 mmHg)
  • personal or family history of known malignant hyperthermia, congenital muscular dystrophy, myasthenia, a known congenital deficit in plasma pseudocholinesterase
  • pregnancy or breast-feeding woman
  • patients under court protection or guardianship
  • absence of insurance covering health costs

Trial locations and contacts

20 sites in 1 country. Contact the study team or a site near you to ask about taking part.

20 sites in 1 country

France20 sites, 20 recruiting
  • Chr Angers

    Angers

    Sigismond LASOCKI, 02 41 35 36 35 ext. +33, silasocki@chu-angers.fr

    Sigismond LASOCKI

    Recruiting
  • CHRU de Brest Hôpital Cavale Blanche

    Brest

    Anais CAILLARD, 02 98 34 76 23 ext. +33, anais.caillard@chu-brest.fr

    Anais CAILLARD

    Recruiting
  • Ch Louis Pasteur

    Chartres

    Nidhal CHEBBI

    Nidhal CHEBBI

    Not yet recruiting
  • CHU Dijon

    Dijon

    Pierre-Grégoire GUINOT, 03 80 28 15 54 ext. +33, guinotpierregregoire@gmail.com

    Pierre-Grégoire GUINOT

    Recruiting
  • CHU Grenoble Alpes

    Grenoble

    Pierre BOUZAT, 04 76 76 72 53 ext. +33, PBouzat@chu-grenoble.fr

    Pierre BOUZAT

    Not yet recruiting
  • CHD Vendée

    La Roche-sur-Yon

    Mathieu OUDOT, 02 51 44 62 37 ext. +33, Mathieu.oudot@chd-vendee.fr

    Mathieu OUDOT

    Recruiting
  • APHP Bicêtre

    Le Kremlin-Bicêtre

    Samy FIGUEIREDO, 01 45 21 34 41 ext. +33, samy.figueiredo@aphp.fr

    Samy FIGUEIREDO

    Not yet recruiting
  • CH Le Mans

    Le Mans

    Laurent BLANCHET, 02 43 43 28 40 ext. +33, lblanchet@ch-lemans.fr

    Laurent BLANCHET

    Recruiting
  • CHU Lille Hopital Salengro

    Lille

    Nathalie BRUNEAU, 03 20 44 59 62 ext. +33, nathaliemarie.bruneau@chru-lille.fr

    Nathalie BRUNEAU

    Recruiting
  • CHU Lille Hôpital Claude Huriez

    Lille

    Cédric CIRENEI, 03 20 44 59 62 ext. +33, cedric.cirenei@chu-lille.fr

    cedric CIRENEI

    Recruiting
  • CHU Lyon Hôpital Sud

    Lyon

    Jean-Stephane DAVID, 04 72 11 73 11 ext. +33, jean-stephane.david@univ-lyon1.fr

    Jean-Stéphane DAVID

    Not yet recruiting
  • HCL Lyon Croix-Rousse

    Lyon

    Alice BLET, 04 72 07 12 39, alice.blet@chu-lyon.fr

    Alice BLET

    Not yet recruiting
  • Chu Nantes (Laennec)

    Nantes, 44093

    Xavier AMBROSI, 02 53 48 27 85 ext. +33, xavier.ambrosi@chu-nantes.fr

    Xavier AMBROSI

    Recruiting
  • Chu Nantes

    Nantes, 44093

    Nicolas GRILLOT, MD, 02 53 48 22 24 ext. +33, nicolas.grillot@chu-nantes.fr

    Antoine ROQUILLY

    Recruiting
  • APHP St-Antoine

    Paris

    Franck VERDON, 01 71 97 70 70 ext. +33, franck.verdonk@aphp.fr

    Franck VERDON

    Not yet recruiting
  • APHP Tenon

    Paris

    Franck VERDONK, 01 71 97 70 70 ext. +33, franck.verdonk@aphp.fr

    Franck VERDONK

    Not yet recruiting
  • CHU Poitiers

    Poitiers

    Quentin SAINT GENIS, 05 49 44 38 95 ext. +33, quentin.saint-genis@chu-poitiers.fr

    Quentin SAINT-GENIS

    Recruiting
  • Hopital Foch

    Suresnes

    Morgan LE GUEN

    Morgan LE GUEN

    Recruiting
  • CHU Toulouse Hôpital Purpan

    Toulouse

    Maxime POMMIER, 05 61 77 23 88 ext. +33, pommier.max@chu-toulouse.fr

    Maxime POMMIER

    Not yet recruiting
  • CHU Toulouse Hôpital Rangueil

    Toulouse

    Francois LABASTE, 05 61 32 28 22 ext. +33, labaste.f@chu-toulouse.fr

    Francois LABASTE

    Not yet recruiting

Other trials in France

About this study

Official title: Best Hypnotic Drug Choice for Rapid Sequence Induction in the Operating Room: a 3-arm Randomized Trial

The best hypnotic choice to optimize the balance between good intubation condition quality and hemodynamic stability during RSI performed in the operating theatre remained to be investigated.

Therefore, a randomized study evaluating the efficacy of propofol, ketamine, and a combination of both is appropriate. So, we designed the HyPnotiKs randomized controlled study to investigate the efficacy of these hypnotic drugs in patients undergoing RSI in the operating theatre. The primary endpoint will be the successful tracheal intubation at the first attempt without major arterial hypotension event.

Being tested
direct IV injection, combination of Ketamine and Propofol
Keywords
Rapid sequence induction, Full stomach patient, hypotension, propofol, ketamine, ketofol, general anesthesia
Medical subject headings
Hypotension

What participants receive

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

  • direct IV injectionDrug

    direct IV injection at dosage of 2 mg/kg (adjusted body weight if BMI > 30) after completing pre-oxygenation

  • combination of Ketamine and PropofolDrug

    combination of Ketamine and Propofol described above: consecutive direct IV injection of Ketamine 1 mg/kg and Propofol 1 mg/kg (adjusted body weight if BMI > 30). Dilution are not necessary.

Study groups in NCT06733129
Study groupRoleWhat they receive
KETOFOLExperimentalKetofol: combination of Ketamine and Propofol : consecutive direct IV injection of Ketamine 1 mg/kg and Propofol 1 mg/kg after completing pre-oxygenation
Receives: Drug: combination of Ketamine and Propofol
KETAMINEExperimentaldirect IV injection at dosage of 2 mg/kg after completing pre-oxygenation
Receives: Drug: direct IV injection
PROPOFOLActive comparatordirect IV injection at dosage of 2 mg/kg after completing pre-oxygenation.
Receives: Drug: direct IV injection

What is being measured

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

  1. proportion of patients with successful intubation at first attempt and without post-induction hypotension

    The main objective of the study is to compare the efficacies of ketamine alone and ketamine-propofol combination compared to standard doses of propofol to achieve successful tracheal intubation on the first attempt without hemodynamic hypotension in patients at risk of aspiration of gastric contents in the operating room. The composite primary outcome is the proportion of patients with successful intubation at first attempt and without post-induction hypotension defined by a mean arterial pressure ≤ 60 mmHg within 10 minutes after the start of the hypnotic injection.

    Measured: within 10 minutes after the start of the hypnotic injection

Secondary outcomes (15)
  1. rates of arterial hypotension episodes

    rates of arterial hypotension episodes as defined in primary endpoint within 10 minutes after induction of anaesthesia compared between the three study groups

    Measured: within 10 minutes after the start of the hypnotic injection

  2. rates of tracheal intubation at the first attempt

    rates of tracheal intubation at the first attempt compared between the three study groups

    Measured: within 10 minutes after the start of the hypnotic injection

  3. quality of the intubation

    In the operating theatre (within 10 minutes after the start of the hypnotic injection): intubation difficulty scale (IDS-3) values

    Measured: within 10 minutes after the start of the hypnotic injection

  4. quality of the intubation

    In the operating theatre (within 10 minutes after the start of the hypnotic injection): Cormack-Lehane score values (from 1 to 4)

    • Cormack 1: The glottis is seen in its entirety
    • Cormack 2: Only the posterior half of the glottis is seen
    • Cormack 3: Only a small part of the glottis is seen
    • Cormack 4: The glottis is hidden by the epiglottis and tongue.

    Measured: within 10 minutes after the start of the hypnotic injection

  5. rates of vasopressor use and volume of intravenous fluids for vascular filling (from entry into the operating theatre to induction and from induction to recovery room)

    In the operating theatre (within 10 minutes after the start of the hypnotic injection): rates of vasopressor use and volume of intravenous fluids for vascular filling (from entry into the operating theatre to induction and from induction to recovery room)

    Measured: within 10 minutes after the start of the hypnotic injection

  6. volume of intravenous fluids for vascular filling

    volume of intravenous fluids for vascular filling (from entry into the operating theatre to induction and from induction to recovery room)

    Measured: up to relapse of the recovery room (up to 7 days after surgery)

  7. time between administration of hypnotic and tracheal intubation

    Efficacy of ketamine and / or ketamine-propofol combination compared to standard doses of propofol on the prevention of postoperative complications in the operating theatre (within 10 minutes after the start of the hypnotic injection) : - time between administration of hypnotic (start of anesthetic induction) and tracheal intubation (defined as the 6th capnography curve)

    Measured: within 10 minutes after the start of the hypnotic injection

  8. values of heart rate

    Efficacy of ketamine and / or ketamine-propofol combination compared to standard doses of propofol on the prevention of postoperative complications in the operating theatre (within 10 minutes after the start of the hypnotic injection) : values of heart rate measured every 1 minute from pre-oxygenation to 10 minutes after the start of the hypnotic injection

    Measured: within 10 minutes after the start of the hypnotic injection

  9. values of SpO2

    Efficacy of ketamine and / or ketamine-propofol combination compared to standard doses of propofol on the prevention of postoperative complications in the operating theatre (within 10 minutes after the start of the hypnotic injection): SpO2 measured every 1 minute from pre-oxygenation to 10 minutes after the start of the hypnotic injection

    Measured: within 10 minutes after the start of the hypnotic injection

  10. values of blood pressure

    Efficacy of ketamine and / or ketamine-propofol combination compared to standard doses of propofol on the prevention of postoperative complications in the operating theatre (within 10 minutes after the start of the hypnotic injection): systolic/diastolic/mean blood pressure measured every 1 minute from pre-oxygenation to 10 minutes after the start of the hypnotic injection

    Measured: within 10 minutes after the start of the hypnotic injection

  11. rates of pulmonary aspiration of gastric contents

    Efficacy of ketamine and / or ketamine-propofol combination compared to standard doses of propofol on the prevention of postoperative complications in the operating theatre (within 10 minutes after the start of the hypnotic injection): rates of pulmonary aspiration of gastric contents during the intubation procedure

    Measured: within 10 minutes after the start of the hypnotic injection

  12. Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol

    Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol in the recovery room by postoperative Nu-DESC (Nursing Delirium Screening Scale) score value compared with preoperative score From 0 to 10

    Measured: during stay in the recovery room

  13. Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol

    Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol in the recovery room: need of sedative therapy in the recovery room to treat a delirium episode.

    Measured: during stay in the recovery room

  14. Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol

    Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol in the recovery room: Use of ketamine and total dose during intervention and total dose of ketamine in recovery room.

    Measured: during stay in the recovery room (up to 7 days after induction)

  15. Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol

    Tolerance of ketamine and / or ketamine-propofol combination compared to standard doses of propofol in the recovery room:

    Up to day 7:

    • rates of major cardiovascular complications defined as: cardiac arrest, sustained arrhythmia, myocardial infarction, stroke (total, ischaemic, and haemorrhagic), coronary revascularization or admission to ICU for acute heart failure
    • rates of mortality at day 7

    Measured: within 7 days after the start of the hypnotic injection

Timeline

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

  1. First posted13 Dec 2024
  2. Study start14 Apr 2025
  3. Primary completion14 Apr 2027 (estimated)
  4. Study completion30 Apr 2027 (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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,218 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06733129
Sponsor's protocol ID
RC24_0389
Acronym
HYPNOTIKS
Status last verified
Nov 2025
First submitted
2 Dec 2024
Last updated
2 Dec 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Grillot N, Volteau C, Quillet P, Ambrosi X, Caillard A, David JS, Blet A, Bouzat P, Blanchet L, Bruneau N, Chebbi N, Saint-Genis Q, Figueiredo S, Guinot PG, Joosten A, Le Guen M, Labaste F, Lasocki S, Oudot M, Pommier M, Rousseleau D, Verdonk F, Tching-Sin M, Faurel-Paul E, Counille F, Cosse C, Flattres Duchaussoy D, Cinotti R, Roquilly A. Best hypnotic drug choice for rapid sequence induction in the operating room: study protocol for a 3-arm superiority open-labeled randomized controlled trial with blinded evaluation of the primary outcome (the HyPnotiKs study). Trials. 2026 Jan 16;27(1):127. doi: 10.1186/s13063-026-09452-6.

    PubMed 41546091

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing direct IV injection and combination of Ketamine and Propofol in people with Rapid Sequence Induction, run by Nantes University Hospital at 20 sites in France.

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 10 inclusion and 12 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: looking for participants now, as of the sponsor's last update on 2 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 20 sites in France. 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 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?

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?

Contact Nicolas GRILLOT, MD (02 53 48 22 24 ext. +33, nicolas.grillot@chu-nantes.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

proportion of patients with successful intubation at first attempt and without post-induction hypotension (time frame: within 10 minutes after the start of the hypnotic injection). 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 NCT06733129, which also lists 1 linked publication.

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 2 Dec 2025; AzTrials last refreshed its copy on 31 Oct 2026.

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