Propofol for Pediatric Tracheal Intubation With Deep Anesthesia During Sevoflurane Induction

NCT01150838 | Completed Phase 4 Results

• 1 other identifier: 13666
• Study Type: interventional
• Target: 106
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to determine the amount of propofol required to achieve 50% of patients obtaining a perfect ("excellent") intubation score of 5 on the Steyn modification of the Helbo-Hansen Intubation Score, when placing a tracheal tube in children 1-6 years and 6-12 years (division of age groups at 6th birthday) of age, under a specific induction and ventilation sequence as specified in this study design.

Conditions

Anesthesia Intubation Complication

Keywords

intubation of children without neuromuscular blockade

Outcome Measures

Primary Outcomes (1)

• Estimated Propofol Doses Producing 50% Excellent Intubation Conditions

  Logistic regression utilized to measure the amount of propofol to obtain 50% excellent intubation conditions for each age/time group. The quality of tracheal intubation will be graded according to the Steyn modification of the Helbo-Hansen scoring system for tracheal intubation, which includes evaluation of ease of laryngoscopy, position of the vocal cords, coughing, jaw relaxation and movement of limbs, each evaluated on a 1-4 scale, with 1 being the best possible condition and 4 the worst. The intubation conditions will be classified as either excellent or not-excellent. "Excellent" will be defined as a total score of 5, a score of 1 for each category, and "not-excellent" will be a total score of 6-20, meaning a score of \>1 in any category. While the outcome measure of each intubation is "excellent" or "not excellent", the overall outcome being generated is the amount of propofol in mg/kg required for 50% excellent intubation score.

  Amount of time it takes to intubate each patient; approximate time is 15-45 seconds

Study Arms (1)

Propofol administration

EXPERIMENTAL

For each of the 6 groups, propofol 2 mg/kg will be administered to first subject. The propofol dose will move separately for each of the 6 groups, and be increased by 0.3 mg/kg for the next subject if intubation score is "not excellent" and decreased by 0.3 mg/kg if intubation score is "excellent". This dosing scheme will be continued until there are 6 "crossovers" as described above.

Drug: propofol

Interventions

propofol DRUG

Initial dose: Propofol 2 mg/kg, then dose changes separately based on the last subject in the same age group and sevo time range

Propofol administration

Eligibility Criteria

• Age: 1 Year - 11 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Informed consent / assent
• Ages 1-11 years (12 - 132 months)
• American Society of Anesthesiology (ASA) physical status 1 or 2, which implies that the patient has no comorbidity that limits daily function.
• Scheduled for non-emergent surgery/ procedure under general anesthesia in which the anesthesia team intends to place an endotracheal tube
• Expected routine intubation according to physical exam and history
• Weight under 50 kg

You may not qualify if:

• Requires neuromuscular blocking agents
• Emergent surgery / procedure
• Expected difficult intubation
• ASA physical status 3 or 4
• Weight over 50 kg
• Age under 12 months or over 132 months
• Allergy to study drugs to be used

Sponsors & Collaborators

• University of Virginia: lead

Study Sites (1)

University of Virginia Health System

Charlottesville, Virginia, 22911, United States

Location

Related Publications (15)

• Politis GD, Tobin JR, Morell RC, James RL, Cantwell MF. Tracheal intubation of healthy pediatric patients without muscle relaxant: a survey of technique utilization and perceptions of safety. Anesth Analg. 1999 Apr;88(4):737-41. doi: 10.1097/00000539-199904000-00009.

  PMID: 10195514 BACKGROUND

• Politis GD, Frankland MJ, James RL, ReVille JF, Rieker MP, Petree BC. Factors associated with successful tracheal intubation of children with sevoflurane and no muscle relaxant. Anesth Analg. 2002 Sep;95(3):615-20, table of contents. doi: 10.1097/00000539-200209000-00022.

  PMID: 12198047 BACKGROUND

• Simon L, Boucebci KJ, Orliaguet G, Aubineau JV, Devys JM, Dubousset AM. A survey of practice of tracheal intubation without muscle relaxant in paediatric patients. Paediatr Anaesth. 2002 Jan;12(1):36-42. doi: 10.1046/j.1460-9592.2002.00727.x.

  PMID: 11849573 BACKGROUND

• Blair JM, Hill DA, Bali IM, Fee JP. Tracheal intubating conditions after induction with sevoflurane 8% in children. A comparison with two intravenous techniques. Anaesthesia. 2000 Aug;55(8):774-8. doi: 10.1046/j.1365-2044.2000.01470.x.

  PMID: 10947692 BACKGROUND

• Dixon WJ. Quantal response to variable experimentation: the up-and-down method. In: McArthur JW, Colton T, eds. Statistics in Endocrionolgy. Cambridge: MIT Press, 1967: 251-264.

  BACKGROUND

• Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, Koscielniak-Nielsen Z, Skovgaard LT, Ostergaard D. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996 Jan;40(1):59-74. doi: 10.1111/j.1399-6576.1996.tb04389.x.

  PMID: 8904261 BACKGROUND

• Steyn MP, Quinn AM, Gillespie JA, Miller DC, Best CJ, Morton NS. Tracheal intubation without neuromuscular block in children. Br J Anaesth. 1994 Apr;72(4):403-6. doi: 10.1093/bja/72.4.403.

  PMID: 8155439 BACKGROUND

• Paul M, Fisher DM. Are estimates of MAC reliable? Anesthesiology. 2001 Dec;95(6):1362-70. doi: 10.1097/00000542-200112000-00014.

  PMID: 11748393 BACKGROUND

• Hansen D, Schaffartzik W, Dopjans D, Heitz E, Striebel HW. Halothane-propofol anaesthesia for tracheal intubation in young children. Br J Anaesth. 1997 Apr;78(4):366-9. doi: 10.1093/bja/78.4.366.

  PMID: 9135352 BACKGROUND

• Min SK, Kwak YL, Park SY, Kim JS, Kim JY. The optimal dose of remifentanil for intubation during sevoflurane induction without neuromuscular blockade in children. Anaesthesia. 2007 May;62(5):446-50. doi: 10.1111/j.1365-2044.2007.05037.x.

  PMID: 17448054 BACKGROUND

• Nishina K, Mikawa K, Shiga M, Maekawa N, Obara H. Oral clonidine premedication reduces minimum alveolar concentration of sevoflurane for tracheal intubation in children. Anesthesiology. 1997 Dec;87(6):1324-7. doi: 10.1097/00000542-199712000-00010.

  PMID: 9416716 BACKGROUND

• Inomata S, Nishikawa T. Determination of end-tidal sevoflurane concentration for tracheal intubation in children with the rapid method. Can J Anaesth. 1996 Aug;43(8):806-11. doi: 10.1007/BF03013033.

  PMID: 8840060 BACKGROUND

• Inomata S, Yamashita S, Toyooka H, Yaguchi Y, Taguchi M, Sato S. Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children. Anaesthesia. 1998 May;53(5):440-5. doi: 10.1046/j.1365-2044.1998.00338.x.

  PMID: 9659016 BACKGROUND

• Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology. 2003 May;98(5):1049-56. doi: 10.1097/00000542-200305000-00005.

  PMID: 12717124 BACKGROUND

• Vakkuri A, Yli-Hankala A, Sarkela M, Lindgren L, Mennander S, Korttila K, Saarnivaara L, Jantti V. Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children. Acta Anaesthesiol Scand. 2001 Aug;45(7):805-11. doi: 10.1034/j.1399-6576.2001.045007805.x.

  PMID: 11472278 BACKGROUND

MeSH Terms

Interventions

Propofol

Intervention Hierarchy (Ancestors)

Phenols; Benzene Derivatives; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons; Organic Chemicals

Results Point of Contact

• Title: George Politis MD
• Organization: University of Virginia

GDP8A@hscmail.mcc.virginia.edu

434-924-2283

Study Officials

• George D Politis, MD

  UVA Department of Anesthesiology

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Attending Anesthesiologist

Model Details: This is a single study with 6 parallel groups as noted in the description. With Dixon's Up and Down Method for determining a 50th percentile of a dichotomous outcome, the number of patients required is not known prior to starting a study. Data from Paul and Fisher demonstrated that 6 "crossovers" (change in the dichotomous outcome from one patient to another, indicating change from increasing the dose of the study drug to decreasing it, or visa-versa). When choosing a meaningful starting point near the 50th percentile, the number required is typically 15-20 patients. With 6 study groups, the estimated number of patients required would be 90-120. Please Note: This is not a study where one can perform a power analysis and determine a required N.

Study Record Dates

• First Submitted: June 2, 2010
• First Posted: June 28, 2010
• Study Start: July 1, 2008
• Primary Completion: June 1, 2010
• Study Completion: June 1, 2010
• Last Updated: February 8, 2021
• Results First Posted: February 8, 2021

Record last verified: 2021-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)