A Phase 4 interventional study of Propofol and Propofol in Thoracic Diseases and Surgery, sponsored by Dr Nitin Sethi. Completed at 1 site in India. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2019-07-02.
Sponsored by Dr Nitin Sethi · Phase 4, Interventional, and Basic science
Automated delivery of propofol using computer-controlled closed loop anaesthesia device delivers propofol based on patient's frontal cortex electrical activity as determined by bi-spectral index (BIS). Evaluation of anaesthesia delivery by these systems has shown that they deliver propofol and maintain depth of anaesthesia with far more precision as compared to manual administration.
By automatically controlling anaesthesia depth consistency they provide time to the anaesthesiologist to focus on other aspects of patient care such as managing intra-operative hemodynamics and ventilation perturbations during major surgeries.
Closed loop anaesthesia delivery system (CLADS) is an indigenously developed continuous automated intravenous infusion system which delivers propofol based on patients EEG profile (BIS) feedback. Although a few studies have already evaluated these automated systems in patients undergoing thoracic surgery, but suffered from significant limitations (small number of patients, not dedicated to thoracic surgery cohort). Currently, there is no data available regarding CLADS performance vis a vis adequacy of GA and haemodynamic profile in patients undergoing thoracic surgery.
We contend that propofol as delivered by CLADS will proffer greater consistency to anaesthesia depth, intra-operative hemodynamic stability, and rapid recovery upon anaesthesia discontinuation than manual means of delivering propofol TIVA. This randomised controlled study aims to compare the efficiency of CLADS-driven propofol TIVA versus manually controlled propofol TIVA in patients undergoing thoracic surgery.
After Ethics Committee approval and written informed consent, thirty-participants (30 per group) aged 18-65 years, ASA physical status I-III, of either sex, and undergoing unilateral open thoracic surgery or unilateral video-assisted thoracic surgery (VATS) will be included in this single centre (Sir Ganga Ram Hospital, New Delhi-110060, India) prospective, single-blinded, two-arm, randomised controlled study.
The patients who qualify inclusion criteria and consent for recruitment will be randomly divided into one of the two groups:
Group-1 [CLADS Group, n=15, Study group]: Anaesthesia will be induced and maintained with propofol administered using the automated CLADS.
Group-2 [Manual Group, n=15, Control group]: Anaesthesia will be induced and maintained with propofol administered using manually controlled infusion pumps titrated to BIS scores.
Sample-size Estimation In a previous multi-centre study, the percentage of time the BIS was within 10 percentage of the target BIS was 81.4 percent in the CLADS group versus 55.34 percent in the manual group. Based on the above, to detect 20 percent difference in the two groups, a sample size of 12 patients per group to provide 90 percent power with a bilateral alpha risk value of 0.05 will be required. We plan to recruit a total of 30 patients to cover up for unanticipated losses after the recruitment.
Randomisation, Allocation Concealment The patients will be randomly allocated to one of the two groups based on a computer-generated random number table. Randomisation sequence concealment will include opaque-sealed envelopes with alphabetic codes whose distribution will be in control of an independent analyst. The envelopes will be opened; patient's data-slip will be pasted on them, and will be sent back to the control analyst.
Blinding Strategy Inside the OR, the attending anaesthesiologist will not be blinded to the technique utilised to administer GA and the recovery parameters immediately after extubation. However, the postoperative patient recovery profile will be evaluated by an independent assessor blinded to the GA technique and periextubation profile.
Management of Anesthesia Two peripheral venous lines (18G/20G catheter) will be secured. Invasive vascular access (arterial line for direct continuous blood pressure assessment, central venous catheter) will be secured as per the requirement of surgery. Standard monitoring (EKG, NIBP, pulse oximeter, EtCO2) will be applied. A BIS sensor (Covidien IIc, Mansfield, USA) will be applied over the patient's forehead according to manufacturer's instructions (Model DSC-XP, Aspect medical system, USA) prior to induction of anaesthesia for continuous monitoring of depth-of-anaesthesia.
Anaesthesia Technique
All the patients will receive pre-induction fentanyl-citrate 2 mcg/kg and anesthesia will be induced with propofol. In the CLADS group, propofol administration rate will be controlled by a feedback loop facilitated by BIS monitoring. A BIS value of 50 will be used as the target point for induction and maintenance of anesthesia. The Manual group would comprise manual propofol administration by an intravenous infusion pump to maintain a target BIS of 50 during induction and maintenance of anesthesia.
After induction of anesthesia, atracurium besylate 0.05mg/kg will be given to facilitate tracheal intubation. In order to facilitate one lung ventilation (OLV) patients trachea will be intubated using appropriate-sized double-lumen tube in all the patients. Oxygen-air mixture (FiO2 0.50) will be used for intraoperative ventilation in both the groups. In addition, starting the period after tracheal intubation, all the patients will receive 1 mcg/kg/hr fentanyl infusion for intraoperative analgesia. Intraoperative muscle relaxation will be maintained using atracurium infusion controlled by train-of-four response on peripheral neuromuscular monitor (Infinity TridentNMT Smartpod, Draeger Medical Systems, Inc Telford, USA).
In all patients undergoing open thoracic surgery, a thoracic epidural catheter will be placed in the indicated intervertebral space for facilitating postoperative analgesia.
Thirty minutes before the end of surgery, non-opioid analgesics, such as paracetamol 1-gm, tramadol 100 mg and/or diclofenac 75 mg will be administered to all the patients. Propofol delivery will be stopped at the point of completion of skin closure. Residual neuromuscular blockade (assessed with train-of-four response) will be reversed with neostigmine (50 µg/kg) and glycopyrrolate (20 µg/kg). Tracheal extubation will be undertaken if planned post-extubation ventilation is not instituted and the patients are wide awake and obeying commands.
Assessment Parameters Intraoperative
Postoperative
After discontinuation of anaesthesia delivery (0-time point) the time to eye opening and time to extubation will be determined. After tracheal extubation, the patients will be shifted to postoperative recovery room adjoining OT suites and will be closely observed for oxygenation and ventilation status, pain (numeric rating score) and sedation. Patients with epidural catheter in-situ will be started with PCEA pump for pain relief. Patients will be analysed for intra-operative awareness using Modified Brice Questionnaire (24 hours, 48 hours postoperatively).
72 studies on the registry are indexed under Thoracic Diseases; 13 are open to participants now.
This study's enrollment of 30 is below the median of 65 across 52 interventional studies indexed under Thoracic Diseases.
Browse Thoracic Diseases studies →Dr Nitin Sethi is the lead sponsor of 3 studies on the registry; none are open to participants now.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
ASA physical status
The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Anaesthesia will be induced and maintained with Propofol administered by CLADS. Its administration rate will be controlled by a feedback loop facilitated by BIS monitoring. A BIS value of 50 will be used as the target point for induction and maintenance of anaesthesia.
Drug: Propofol
Anaesthesia will be induced and maintained with propofol administration by an intravenous infusion pump. Its administration rate will be controlled manually to maintain a target BIS of 50 during induction and maintenance of anaesthesia.
Drug: Propofol
Propofol delivery will be controlled using automated closed loop anaesthesia delivery system which will control propofol delivery rate to consistent anaesthetic depth (BIS-50) feedback from the patient (CLADS group)
Propofol delivery will be controlled using infusion pumps which will be manually controlled to deliver propofol to maintain consistent anaesthetic depth (BIS-50). (Manual group)
Anaesthesia depth consistency using BIS scores
Determined by the percentage of the total anaesthesia time in which the BIS scores remain within a score of 10% of the target BIS (i.e. BIS-50) in both the study arms.
Time frame: From beginning of anaesthesia (0-hours, baseline) till 10 hours intraoperatively
Performance Characteristic of propofol anaesthesia delivery system
Determined by using Varvel criteria parameters; median performance error (MDP), median absolute performance error (MDAPE), wobble and global score in both the study arms
Time frame: From beginning of anaesthesia (0-hours, baseline) till 10 hours intraoperatively
Change in Intra-operative heart Rate (beats per minute)
Comparison of intra-operative heart rate between both the arms will be done
Time frame: From beginning of anaesthesia (0-hours, baseline) till 10 hours intraoperatively
Change in Intra-operative systolic , diastolic, and mean (mmHg)
Comparison of intra-operative blood pressure- systolic, diastolic, and mean between both the arms will be done
Time frame: From beginning of anaesthesia (0-hours, baseline) till 10 hours intraoperatively
Recovery from anesthesia
Time taken by the patient to open his/her eyes after discontinuation of anaesthesia will be noted
Time frame: From end of anaesthesia till 20-minutes postoperatively]
Recovery from anesthesia
Time taken for tracheal extubation after discontinuation of anaesthesia will be noted
Time frame: From end of anaesthesia till 20-minutes postoperatively]
Intra-operative awareness
Will be assessed using modified brice questionnaire
Time frame: From the end of anaesthesia till 48-hours postoperatively
Propofol induction dose (mg)
Dose of propofol required for induction of anaesthesia
Time frame: From start of propofol injection till 2- minutes intraoperatively
Propofol maintenance dose (mg/kg/hr)
Dose of propofol required for maintenance of anaesthesia
Time frame: From 2-minutes intraoperatively till 10-hours intraoperatively
Plan to share: No
No publications or documents are linked to this record.
Ran from Oct 2017 to primary completion in Jun 2019, 19 months.
How these figures are worked out, and which studies are left out of them.
This study is completed, as verified in Jun 2019. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Studies of the drug tested here: Propofol