Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03085563
Other study ID # 16-1909
Secondary ID
Status Completed
Phase Phase 4
First received
Last updated
Start date May 24, 2017
Est. completion date November 8, 2018

Study information

Verified date April 2022
Source University of Colorado, Denver
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The objective of this project is to compare the sedative effects of intranasal midazolam versus inhaled nitrous oxide (N2O) for minor procedures in the pediatric emergency department. The primary outcome will be length of stay (LOS) in the emergency department (ED) stay for minor procedures. Secondarily the investigators will compare patient/family and provider satisfaction while using either intranasal midazolam or N2O for minimal sedation. The investigators hypothesize that the total length of stay for children undergoing minor procedures in the ED will be lower for N2O, as compared to intranasal midazolam. The investigators also hypothesize that patient/family and provider satisfaction will be higher with N2O and adverse effects will not differ between N2O and intranasal midazolam. Patients will receive either intranasal midazolam or N2O for minor procedures. Following the enrollment period, data will be analyzed and the two will be compared. Total length of stay, patient/family and provider satisfaction will be studied.


Recruitment information / eligibility

Status Completed
Enrollment 63
Est. completion date November 8, 2018
Est. primary completion date November 8, 2018
Accepts healthy volunteers No
Gender All
Age group 2 Years to 17 Years
Eligibility Inclusion Criteria: 1. Patients =2 years of age and <18 years of age, and 2. Parent/legal guardian age =18 years of age to <80 years of age 3. Patients with an American Society of Anesthesiologists (ASA) Physical Status Classification System level 1, 2, and 3 4. Patients requiring anxiolysis and mild sedation for minor procedures 1. Minor procedures will include simple lacerations less than 4 cm 2. Lumbar punctures 3. Minor incision 4. Drainage of abscesses that do not require extensive debridement 5. Must receive the standard of care dosing for either nitrous oxide or intranasal midazolam. 1. Nitrous oxide up to 70% nitrous concentration will be allowed 2. Intranasal Midazolam 0.4mg/kg with a max dose of 10mg Exclusion Criteria: 1. Nasal injury, nasal obstruction or significant congestion 2. Laceration that involves the nose and ears or come into contact with the scavenger device or nitrous oxide tubing 3. Allergy to benzodiazepines 4. Benzodiazepine dosing for any reason 24 hours prior to procedure 5. Excessive Epistaxis 6. Facial or nasal deformity 7. Copious mucous 8. Recent (less than 1 week) tympanic membrane graft or middle ear surgery 9. Recent bleomycin therapy 10. Patients known to be pregnant at time of enrollment 11. Patients with severe behavior problems, personality disorders or other mind-altering conditions as determined by administering provider. 12. Closed space situations such as: 1. pneumothorax, 2. air embolus, 3. pneumocephalus, or 4. craniotomy in the last 3 weeks, 5. intraocular surgery with retained gas, 6. pulmonary bullae, 7. severe emphysema, or 8. bowel obstruction. 13. Patients with significant co-morbidities: 1. severe pulmonary disease, 2. cardiac disease, 3. hematologic diseases associated with B12 deficiency, 4. sickle cell disease. 14. Patients with acute otitis media and/or sinusitis 15. History of paradoxical reaction to nitrous oxide 16. Known Methicillin-resistant Staphylococcus aureus (MRSA+) patients 17. Co-administration of additional sedation or analgesic medications

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Nitrous Oxide
Nitrous oxide will be delivered in one of two ways, using the titration method or rapid infusion method. Which ever method is used will be recorded. When using the titration method, starting at 20%, nitrous oxide will be added in 10% increments every 60 seconds until the ideal level of sedation has been met (not to exceed 70% nitrous oxide). Using the rapid infusion method, after the proper flow rate has been achieved with oxygen, the flowmeter will be increased to obtain 50% concentration of nitrous oxide. After 2-3 minutes if the patient does not have adequate sedation, nitrous oxide concentration will be increased to 70%.
Midazolam
Intranasal midazolam with mucosal atomizer device administration will follow the Children's Hospital Colorado (CHCO) established policy 'Intranasal Administration (atomization) of Medications'. As per standard of care, each patient will receive a standardized dose of 0.4mg/kg (maximum dose of 10mg) of intranasal midazolam with the mucosal atomizer device for all procedures.

Locations

Country Name City State
United States Children's Hospital Colorado Aurora Colorado

Sponsors (1)

Lead Sponsor Collaborator
University of Colorado, Denver

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary ED Length of Stay After Intranasal Midazolam or Nitrous Oxide Administration The total length of Emergency Department (ED) stay will be defined as time from intranasal midazolam or nitrous oxide administration to time of discharge readiness, collected by the research assistants. Additional time periods measured will include: time from anxiolytic/sedative given to time of procedure completion, and total time for recovery. From administration of intranasal midazolam or nitrous oxide, assessed over an estimated time of 2 hours.
Secondary Patient/Parent and Provider Satisfaction With Sedation and Anxiolytic/Sedative. Patient/parent satisfaction will be assessed for all patients; child satisfaction will be assessed for patients over 12 years of age. Satisfaction will be measured on a scale of 1 to 5 (1 being not satisfied and 5 being very satisfied). Specifically, parents (and children when applicable) will be asked "how satisfied with the means of sedation were you for the procedure performed". Research assistants will then ask the ED providers on a scale of 1 to 5 (1 being not satisfied and 5 being very satisfied) "how satisfied with the means of sedation were you for the procedure performed". Time of discharge, Approximately 2 hours
Secondary Adverse Events. Number of adverse events observed. Adverse events will be classified and defined as hypoxia, need for administration of reversal agent, nausea, vomiting, paradoxical reaction, airway obstruction, laryngospasm, inadequate sedation, allergic reaction, and cardiac arrest. Time of discharge, Approximately 2 hours
See also
  Status Clinical Trial Phase
Terminated NCT02573818 - Sedasys Post Approval Study Users Response to System Alarms N/A
Recruiting NCT01100554 - Upper Airway Collapsibility Evaluation in Different Sedative Levels by Sleep Endoscopy N/A
Terminated NCT00226785 - Dexmedetomidine for Continuous Sedation Phase 3
Completed NCT02518919 - Procedural Sedation And Analgesia in Children in the Emergency Department: The Role of Adjunct Therapies N/A
Enrolling by invitation NCT04172415 - Current Procedural Sedation Practices in a Canadian Community Emergency Department
Completed NCT01020643 - Closed-loop Sedation of Propofol for Patients Undergoing Spinal Anesthesia Phase 4
Completed NCT00318955 - Post-Marketing Clinical Study to Assess Efficacy and Safety of Dexmedetomidine in Post-Operative Patients Phase 4
Completed NCT04621526 - Monitored Anesthesia Care: Dexmedetomidine-Ketamine Versus Dexmedetomidine- Propofol For Chronic Subdural Hematoma Phase 1/Phase 2
Completed NCT01873612 - Acute Ventilatory Response to Hypoxia During Sedation With Dexmedetomidine Compared to Propofol in Healthy Male Volunteers Phase 4
Not yet recruiting NCT03466242 - IN Dexmedetomidine for Procedural Sedation in Pediatric Closed Reductions for Distal Forearm Fractures Early Phase 1
Completed NCT02679781 - Nasal Versus Oral Midazolam Sedation in Routine Pediatric Dental Care N/A
Completed NCT03885427 - Analgo-Sedative Effects Of Oral, Or Nebulized Ketamine In Pre-schoolers Undergoing Elective Surgery. Early Phase 1
Completed NCT00452426 - Safety and Effectiveness of a Computer-Assisted Personalized Sedation (CAPS) Device for Propofol Delivery During Endoscopy Phase 3
Completed NCT00261599 - An Effectiveness and Safety Study of AQUAVAN® Injection (Fospropofol Disodium) for Sedation During Colonoscopy Phase 3
Completed NCT00641563 - Effects of Two Different Sedation Regimes on Auditory Evoked Potentials and Electroencephalogram (EEG) N/A
Active, not recruiting NCT01118884 - Effects of Oral Midazolam in Comparison Promethazine With Nitrous Oxide for Uncooperative Children Phase 3
Terminated NCT00809380 - Parental Presence During Fracture Reduction in Children at the Emergency Department; A Randomized Controlled Trial N/A
Completed NCT03886454 - Incidence and Nature of Respiratory Impairment in Consecutive Patients Undergoing Bronchoscopy Under Conscious Sedation: A Pilot Study
Completed NCT03925779 - Conscious Sedation for Outpatient Colonoscopy Phase 2
Completed NCT06181188 - Use of Ketamine for Conscious Sedation in Flexible Bronchoscopy Phase 4