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Trial record 33 of 575 for:    CARBON DIOXIDE AND anesthesia

Isocapnic Hyperventilation - an Alternative Method

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ClinicalTrials.gov Identifier: NCT03074110
Recruitment Status : Completed
First Posted : March 8, 2017
Last Update Posted : January 2, 2018
Sponsor:
Information provided by (Responsible Party):
Katarina Hallén, Sahlgrenska University Hospital, Sweden

Brief Summary:
Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia by increasing airway carbon dioxide (CO2) during hyperventilation (HV). In two experimental studies (mechanical lung model and porcine model) and in a pilot study on patients undergoing sevoflurane anaesthesia for major ear-nose-throat (ENT) surgery, the investigators evaluated the feasibility of an alternative technique of IHV. By performing a prospective, randomised controlled study, the investigators want to further test this alternative method for IHV.

Condition or disease Intervention/treatment Phase
Oropharyngeal Neoplasms Device: Isocapnic hyperventilation Not Applicable

Detailed Description:

Isocapnic hyperventilation (IHV) provides an alternative method for weaning from inhalation anaesthesia which decreases the time to eye-opening, extubation and time spent in the PACU. The method is well known since at least 40-50 years and involves the maintenance of a stable CO2 level during hyperventilation, which increases the elimination of anaesthetic gas without producing hypocapnia. Studies have declared that the reduction in time to eye-opening is 50-60 % compared to a standard weaning procedure after inhalation anaesthesia.

There are several principally different ways to maintain the CO2 level during hyperventilation, where a number of technical solutions that add dead-space to the anaesthesia circuit and thereby produce rebreathing of CO2 during hyperventilation are the most studied methods so far. However, the original method of directly adding CO2 to the breathing circuit during hyperventilation could be considered in need of a re-evaluation, as modern anaesthesia delivery units and monitoring equipment to a great extent can eliminate the risk of hypercapnia, that was described with this procedure in the 1980ies.

An alternative IHV method is to directly infuse CO2 to the inspiratory limb of the breathing circuit through a mixing box while using mechanical hyperventilation by a standardised protocol. This technique was recently evaluated by the investigators, in a bench test, and in an in vivo model. Based on these studies, the CO2 dosage needed to achieve isocapnia during HV at various levels of alveolar ventilation, CO2 production and dead space was estimated and a gender- and weight-based nomogram for CO2 delivery during IHV was constructed. Furthermore, the investigators could show, in vivo, that the washout time of sevoflurane anaesthesia was one-third compared to normal ventilation. The feasibility of this IHV method was evaluated in a pilot study in humans, based on the results of our two previous experimental studies. To finalize the project the investigators now conduct a prospective randomized trial to evaluate the efficacy of the method, compared to a standard weaning procedure, after long-term sevoflurane anaesthesia.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 31 participants
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Isocapnic Hyperventilation for Enhancing Recovery After Inhalation Anaesthesia - an Alternative Method
Actual Study Start Date : November 11, 2016
Actual Primary Completion Date : August 15, 2017
Actual Study Completion Date : August 15, 2017

Arm Intervention/treatment
Active Comparator: Isocapnic hyperventilation
After end of surgery, hyperventilation and administration of a small, precalculated amount of CO2 into the breathing circuit will be performed.
Device: Isocapnic hyperventilation
Mechanical hyperventilation to enhance elimination of inahalation anesthetics. Administration of a precalculated flow of CO2 according to gender and weight into the inspiratory limb of the breathing circuit in order to avoid hypocapnia.
Other Name: Normocapnic hyperventilation

No Intervention: Standard procedure
After end of surgery, patients will be subdued to a standard weaning procedure.



Primary Outcome Measures :
  1. Time to extubation [ Time Frame: 5-20 minutes ]
  2. Time to eye-opening [ Time Frame: 10-25 minutes ]
  3. Time to discharge from OR [ Time Frame: 15-40 minutes ]

Secondary Outcome Measures :
  1. Postoperative recovery [ Time Frame: 60 minutes ]
    Postoperative quality of recovery (PQRS) scale

  2. Time to eligible for discharge from post-anaesthesia care unit (PACU) [ Time Frame: 1-6 hours ]


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Adult patients scheduled for major elective ear-nose-throat (ENT) surgery after informed consent was obtained during the pre-operative evaluation.

Exclusion Criteria:

  • Patients with severe pulmonary or circulatory disease

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03074110


Locations
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Sweden
Sahlgrenska University Hospital
Gothenburg, Sweden, 41345
Sponsors and Collaborators
Sahlgrenska University Hospital, Sweden

Publications:
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Responsible Party: Katarina Hallén, Consultant, Sahlgrenska University Hospital, Sweden
ClinicalTrials.gov Identifier: NCT03074110     History of Changes
Other Study ID Numbers: GLS-588681
First Posted: March 8, 2017    Key Record Dates
Last Update Posted: January 2, 2018
Last Verified: December 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Katarina Hallén, Sahlgrenska University Hospital, Sweden:
Inhalation Anaesthetics, Sevoflurane
Carbon Dioxide
Hyperventilation
Anaesthesia Recovery Period
Ventilators
Additional relevant MeSH terms:
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Anesthetics
Oropharyngeal Neoplasms
Hyperventilation
Respiration Disorders
Respiratory Tract Diseases
Signs and Symptoms, Respiratory
Signs and Symptoms
Pharyngeal Neoplasms
Otorhinolaryngologic Neoplasms
Head and Neck Neoplasms
Neoplasms by Site
Neoplasms
Pharyngeal Diseases
Stomatognathic Diseases
Otorhinolaryngologic Diseases
Central Nervous System Depressants
Physiological Effects of Drugs