Anesthesia Clinical Trial
Official title:
The Effect of Low Dose Intra-operative Ketamine on Closed-loop Controlled General Anesthesia
Closed-loop control of anesthesia involves using feedback from a measure of clinical effect
to continuously adjust drug infusion rates. As a result, anesthetic drugs are delivered at a
variable rate that is frequently personalized to each individual patient. The aim is to
provide greater stability at an optimal depth of anesthesia, reducing the occurrence of
under- or overdosing, with the goal of ultimately improving patient outcomes.
The purpose of this randomized, controlled equivalence trial is to compare controller
performance during closed-loop controlled induction and maintenance of total intravenous
anesthesia, using iControl system, with the addition of a low (analgesic) dose of ketamine
versus saline control.
For the primary outcome measure, the investigators hypothesize that controller performance
with low-dose ketamine will be equivalent to the controller performance without low-dose
ketamine. The primary outcome measure, controller performance, is the percentage of time
during the maintenance phase when the depth-of-hypnosis (DOH) measure is within +-10 points
of the set point in patients receiving low dose ketamine versus those receiving saline
control.
This study will consider other clinical data of interest from both intra- and post-operative
contexts in order to establish a broader understanding of the potential implications of the
use of a low dose of ketamine during closed-loop controlled anesthesia. In the OR, the
investigators will record other indications of anesthetic quality, such as vital signs and
the occurrence of any unwanted intra-operative events. Propofol and remifentanil consumption
will be quantified, and the requirement of any other interventions will be recorded. The
investigators will also record post-operative patient outcomes that have previously been
associated with ketamine administration, such as acute post-operative pain intensity, opioid
requirements, the occurrence of PONV, and shivering occurring in the post-anesthesia care
unit (PACU).
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