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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04519203
Other study ID # R20006
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date September 9, 2020
Est. completion date November 1, 2021

Study information

Verified date April 2021
Source Tampere University Hospital
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Surgical Pleth Index (SPI) is an intraoperative monitor aimed into detection of nociception and guidance of intraoperative opioid administration. Using such a device opioid administration could be potentially optimized during intraoperative period. this study will aim to show whether SPI could be used to reduce unwanted events and lower opioid consumption in gastroenterological surgery. The study will be blinded and randomized including two study arms with either SPI monitoring included or standard monitoring alone.


Description:

Patients are extensively monitored intraoperatively. Even though there are monitors for the measurement of nociception, it has not gained wide acceptance partly because of limited and scarce evidence on the efficacy and optimal use. Especially elderly patients undergoing major operation might benefit from optimization of opioid administration. Surgical Pleth Index (SPI) is an intraoperative monitoring aimed for detection of nociceptive stimulus. The aim of this research is to study whether SPI could be used to guide opioid administration in gastroenterological surgery. The study will consist of a total 80 patients which are randomized into two groups. The study sample is based on power calculation for the reduction of remifentanil consumption. In the study group the opioid administration will be guided using a SPI based protocol. In the control group the opioid administration will be based on standard monitoring and clinical decision alone. The aim of the study will be to study whether opioid administration optimized using SPI can lover need for anticholinergic drugs, reduce need for opioids or diminish the amount of unwanted side effects postoperatively. The patients will be treated using target controlled infusions of remifentanil and propofol. The data will be collected intraoperatively using electronic software and using a study data collection form by study personel. All study procedures will take place during operative period. The study power was calculated using a study comparing depth of anesthesia and depth of nociception balance-controlled group into a group without these monitors. In the group with monitoring the consumption of remifentanil was 9,5±3.8 mg/kg/h while in the unmonitored group the consumption was 12.3 mg/kg/h(Chen, 2010). While taking into notice α= 0,005 and β=90% a number of 39 patients in each group is needed. Based on these we chose 80 patients to be included in the study. All collected data will be used into statistical analysis ass applicable. Statistical analysis plan describing the analytical principles and statistical techniques to be employed in order to address the primary and secondary objectives, as specified in the study protocol or plan.


Recruitment information / eligibility

Status Completed
Enrollment 80
Est. completion date November 1, 2021
Est. primary completion date November 1, 2021
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 50 Years and older
Eligibility Inclusion Criteria: - Able to provide a written informed consent - Age 50 years or above - Laparoscopic or laparotomic surgery requiring intubation with an expected intraoperative time at least two hours. - ASA classification 1-3 Exclusion Criteria: - Implanted cardiac pacemaker or known condition with irregular heart rate at the time of inclusion or induction - Chronic use of opioids - BMI >35 - Known allergy for study medications - Over 5 extrasystoles per minute at the time of induction or inclusion - The use of epidural catheter during the last one hour before surgery or need for catheter intraoperatively (if new catheter is placed at the beginning of surgery test dosage may be used without the need for patient exclusion)

Study Design


Intervention

Device:
SPI
Either standard monitoring alone or added with SPI
Standard
Standard monitoring alone

Locations

Country Name City State
Finland Tampere University Hospital Tampere

Sponsors (2)

Lead Sponsor Collaborator
Tampere University Hospital general electric healthcare Finland

Country where clinical trial is conducted

Finland, 

Outcome

Type Measure Description Time frame Safety issue
Primary Intraoperative remifentanil consumption The consumption of the remifentanil intraoperatively intraoperative time
Secondary severe hypotension MAP <55 mmHg, or -30% from the baseline value intraoperative time
Secondary intermediate hypotension MAP <65 mmHg, or -20% from the baseline value intraoperative time
Secondary hypertension RRsys >140 mmHg or +20 % from baseline value intraoperative time
Secondary Bradycardia Heart rate<45 intraoperative time
Secondary tachycardia Heart rate>90 intraoperative time
Secondary Inraoperative propofol consumption intraoperative time
Secondary Desorientation/ grade of sedation during postoperative care treatment The postoperative desoroentation during immediate post-operative period at postanesthesia care unit. Measured using modified aldrete score 2-4 hours
Secondary Postoperative nausea and vomiting The postoperative nausea and vomiting during immediate post-operative period at postanesthesia care unit. Measured using modified aldrete score. 2-4 hours
Secondary Postoperative opioid consumption The postoperative opioid consumption during immediate post-operative period at postanesthesia care unit. 2-4 hours
Secondary Fading of intraoperative relaxation The characteristics of intraoperative relaxation using EMG measurement intraoperative time
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