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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04414228
Other study ID # N202004045
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date June 19, 2020
Est. completion date November 18, 2021

Study information

Verified date May 2022
Source Taipei Medical University Shuang Ho Hospital
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Patients undergoing thoracotomy in thoracic surgery are prone to have complications of delayed recovery from general anesthesia and perioperative instable hemodynamics due to the relatively invasive procedures and patient's underlying morbidity. Therefore, intraoperative monitoring and corresponding management are of great importance to prevent relevant complications in thoracic surgery. This study aims to investigate the clinical benefits of two intraoperative monitoring techniques in patients undergoing thoracotomy surgery, including depth of anesthesia and minimally invasive cardiac output monitoring. First, M-Entropy system will be used to measure the depth of anesthesia and be evaluated regarding the effect of spectral entropy guidance on postoperative recovery. Second, we will apply ProAQT device in guiding goal-directed hemodynamic therapy and assess its impact on occurrence of postoperative pulmonary complications and recovery. In this study, we will conduct a factorial parallel randomized controlled trial and use the method of stratified randomization to evaluate both two monitoring technologies in the same patient group. The results of this study will provide important evidence and clinical implication for precision anesthesia and enhanced recovery after surgery (ERAS) protocol in thoracic surgery.


Recruitment information / eligibility

Status Completed
Enrollment 76
Est. completion date November 18, 2021
Est. primary completion date November 18, 2021
Accepts healthy volunteers No
Gender All
Age group 20 Years and older
Eligibility Inclusion Criteria: - Patients undergoing video-assisted thoracotomy for lung resection at Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. Exclusion Criteria: - Age < 20 years - Pregnancy - End-stage renal disease - Emergency surgery - Presence of circulatory shock needing vasoactive drugs before surgery - Any diagnosis of aortic diseases - Cerebral vascular diseases or trauma - High-degree cardiac arrythmia (e.g. atrial fibrillation) - Uses of cardiac pacemaker or automated implantable cardioverter defibrillator - New York Heart Association functional classification 4 - Long-term use of psychiatric medications - Intraoperative blood loss > 1 L - Intraoperative blood transfusion - Planned or unanticipated transferal to ICU for postoperative mechanical ventilation - Patient refusal to participate

Study Design


Related Conditions & MeSH terms


Intervention

Device:
M-Entropy guidance of anesthesia depth
In the M-Entropy group, dosage of volatile anesthetics will be adjusted to achieve the response and state entropy values between 40 and 60 from the start of anesthesia to the end of surgery. In the control group, dosage of volatile anesthetics will be titrated according to clinical judgment.
ProAQT in guiding goal-directed hemodynamic therapy
If stroke volume variation is = 10%, a bolus of 150 ml of crystalloid fluid will be given until the stroke volume variation is < 10%. If mean arterial pressure is < 70 mmHg and/or cardiac index < 2.5 l·min-1·m-2 despite the stroke volume variation of < 10% following fluid challenge, single or consecutive boluses of ephedrine 4 mg and/or continuous intravenous infusion of norepinephrine 2-10 µg·min-1 will be administered.

Locations

Country Name City State
Taiwan Shuang Ho Hospital, Taipei Medical University Taipei

Sponsors (1)

Lead Sponsor Collaborator
Taipei Medical University Shuang Ho Hospital

Country where clinical trial is conducted

Taiwan, 

Outcome

Type Measure Description Time frame Safety issue
Primary Time to spontaneous eye opening The interval from the cessation of anesthetics to spontaneous eye opening At the end of surgery
Primary Rate of in-hospital postoperative pulmonary complications This includes atelectasis, pleural effusion, pneumonia, empyema, pulmonary embolism, re-operation, and respiratory failure. The diagnosis of atelectasis and pleural effusion will be made based on routinely performed chest radiographs on postoperative days 1 and 3. Pneumonia will be diagnosed if a patient presents with fever, leukocytosis and new infiltrates on chest radiography. Pleural empyema and pulmonary embolism will be confirmed by spiral computed tomography scan. Respiratory failure is defined as described in the protocol. Within 30 days after surgery
Secondary Time to tracheal extubation The interval from the cessation of anesthetics to tracheal extubation At the end of surgery
Secondary Time to orientation in time and place The interval from the cessation of anesthetics to orientation in time and place At the end of surgery
Secondary Time to leave operating room The interval from the cessation of anesthetics to leave operating room At the end of surgery
Secondary Rate of emergence agitation Richmond Agitation-Sedation Scale will be used to evaluate the level of agitation and sedation promptly after extubation. This is defined as +4 combative, +3 very agitated, +2 agitated, +1 restless, 0 alert and calm, -1 drowsy, -2 light sedation, -3 moderate sedation, -4 deep sedation, and -5 unarousable. During the recovery from anesthesia
Secondary Rate of postoperative delirium Events of delirium will be evaluated using the Confusion Assessment Method at the postanesthetic care unit. 30 minutes after tracheal extubation
Secondary Rate of intraoperative recall or awareness As titled One day after surgery
Secondary Arterial partial pressure of oxygen (PaO2) / fraction of inspired oxygen (FiO2) The relative change of PaO2/FiO2 values after induction of anesthesia and at the end of surgery After induction of anesthesia and at the end of surgery
Secondary Rate of cardiac complications Myocardial infarction diagnosed by electrocardiogram and troponin T serum concentration; newly developed atrial fibrillation. Within 30 days after surgery
Secondary Rate of hypotensive episodes This is defined as a decrease in mean arterial pressure > 20% for more than 15 min requiring vasopressors. Within 30 days after surgery
Secondary Rate of newly developed stroke This will be based on the finding of imaging tests. Within 30 days after surgery
Secondary Length of hospital stay As titled Within 30 days after surgery
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