Post Operative Hemodynamic Function After Anesthetic Induction With Etomidate for Cardiac Surgery With ECC

This study has been completed.
Sponsor:
Information provided by:
Centre Hospitalier Universitaire de Saint Etienne
ClinicalTrials.gov Identifier:
NCT00451776
First received: March 22, 2007
Last updated: October 29, 2008
Last verified: October 2008
  Purpose

Because of its hemodynamic safety, etomidate is widely used for anaesthesia induction of cardiac surgery. It can also cause adrenal insufficiency during the following 48 hours ( 11 betahydroxylase inhibition ). So it could increase hemodynamic dysfunction caused by the SIRS following cardiopulmonary bypass.

A previous observational study found more adrenal insufficiency and need for vasopressive support therapy in the etomidate group versus another propofol induced group.

The aim of our work is to compare hemodynamic dysfunction following induction with etomidate for cardiac surgery with ECC. The control group would be induced by Propofol. 94 patients would be included.


Condition Intervention Phase
Cardiac Surgery
Drug: etomidate
Drug: propofol
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: Post Operative Hemodynamic Function After Anesthetic Induction With Etomidate for Cardiac Surgery With ECC. A Prospective, Monocentric, Randomised Double Blind Study

Resource links provided by NLM:


Further study details as provided by Centre Hospitalier Universitaire de Saint Etienne:

Primary Outcome Measures:
  • Time to discharge to vasoactive supportive therapy in the first 48 post operative hours . [ Time Frame: 48 hours ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Hemodynamic supportive drugs ( I .e : dodutamine and noradrenaline ) doses at different time . [ Time Frame: several times ] [ Designated as safety issue: No ]
  • Systematic inflammatory response intensity [ Time Frame: 6 hours ] [ Designated as safety issue: No ]
  • Hemodynamic supportive drugs consumption in patients with SIRS sub group [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
  • Myocardial infarction incidence in the first 48 postoperative hours . [ Time Frame: 48 hours ] [ Designated as safety issue: Yes ]
  • In hospital mortality [ Time Frame: day of hospital coming out ] [ Designated as safety issue: Yes ]

Enrollment: 100
Study Start Date: June 2007
Study Completion Date: October 2008
Primary Completion Date: October 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
patients who received etomidate
Drug: etomidate
patients who received etomidate
Active Comparator: 2
patients who received propofol
Drug: propofol
patients who received propofol

Detailed Description:

Information will be given at the anaesthetic consultation, few weeks before planed cardiac surgery. Eligibility and exclusion criteria will be checked. Patient will receive an informative written consent notice and all questions will be answered. A standard pre-operative blood collection will be sampled.

In order to minimize the potential confusing effect of daily cortisol variation, only surgical procedure performed early morning will be considered. The day before surgery definitive inclusion will be decided as the order of procedure is not known before. Only patients operated in the morning will be included because of cortisol daily variations. At this time, consent and information notice will be signed and checked in the medical record.

On the morning of surgery, during venous catheter insertion an additional blood sample will be collected to asses basal cortisolemia.

Randomisation will be carried out centrally after patient operative theatre admission, by phone call from ICU to randomisation office. Hypnotic drug will be prepared in the ICU department next to the operative room and blindly administered to patient ( same volume per weight ). All other anesthetic procedures will be standardised : opioid drugs, vasopressive support, antifibrinolytics and hemodynamic monitoring.

After surgery patients are admitted to surgical ICU. They will undergo standard post operative exams plus two corticotrophin tests and a dosage of SIRS markers ( IL6 and TNF alpha ). These results will only be known at the end of the study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • age superior to 18 years
  • patient which had to be operated for aorto-coronary pass and/or valvular replacement

Exclusion Criteria:

  • patient with aortics shrinking
  • women pregnant or nursing
  • contra-indication to etomidate or diprivan or synacthene
  • patient with insufficiency kidney
  • patient with infection
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00451776

Locations
France
University hospital
Saint-Etienne, France, 42055
Sponsors and Collaborators
Centre Hospitalier Universitaire de Saint Etienne
Investigators
Principal Investigator: Jérome MOREL, MD Centre Hospitalier Universitaire de Saint Etienne
  More Information

No publications provided

Responsible Party: Dr Jérôme MOREL, Centre Hospitalier Universitaire de Saint Etienne
ClinicalTrials.gov Identifier: NCT00451776     History of Changes
Other Study ID Numbers: 0608119, 2006-007017-21
Study First Received: March 22, 2007
Last Updated: October 29, 2008
Health Authority: France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)

Keywords provided by Centre Hospitalier Universitaire de Saint Etienne:
cardiac surgery
adrenal insufficiency
etomidate
propofol

Additional relevant MeSH terms:
Etomidate
Propofol
Anesthetics
Hypnotics and Sedatives
Central Nervous System Depressants
Physiological Effects of Drugs
Pharmacologic Actions
Central Nervous System Agents
Therapeutic Uses
Anesthetics, Intravenous
Anesthetics, General

ClinicalTrials.gov processed this record on October 19, 2014