Evaluation of Safety and Efficacy of Non-anesthesia Provider-administered Different Anesthetic Regimens During Colonoscopy. Asingle Center, Prospective Double Blind, Randomized Study
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 发起方
- 入组人数
- 183
- 试验地点
- 2
- 主要终点
- Degree of sedation
研究概览
简要总结
This is a randomized, double-blinded, prospective study which will be conducted at the Department of Gastroenterology, King Saud Hospital, Unaizah, Qassim, Saudi Arabia. This study aims to compare safety and efficacy of different types of sedation medications for elective colonoscopy. Colonoscopy is a procedure to examine and visualize the colon by a fiberoptic tube called colonoscope. Sedation helps one to relax to avoid feel any discomfort or pain during the procedure.
详细描述
The study will involve 157 patients who meet the inclusion criteria and are scheduled for elective colonoscopy. Sample size is calculated by ANOVA F test. Participants will be randomly assigned into three groups using computer-based randomization. Group I will receive intravenous midazolam + fentanyl, Group II will receive propofol only, and Group III will receive fentanyl + propofol. Dosages will be titrated as needed during the procedure, with sedation administered by trained nurses/doctors under the supervision of an anesthesiologist to ensure patient safety. Experienced endoscopists will perform the procedures, and all participants will undergo a pre-procedure evaluation, including medical history, physical examination, and assessment of allergies, comorbidities, and ASA classification. Data on patient demographics, procedure details, and sedative dosages will be collected, alongside monitoring of vital signs, oxygen saturation, and blood pressure before, during, and after the procedure.
The primary outcomes for the study include the degree of sedation, onset of sedation, patient satisfaction, and procedure completion rate. The degree of sedation will be assessed using the Observer's Assessment of Alertness/Sedation (OAA/S) scale, while the onset of sedation will be defined as the time it takes for the patient to show drowsiness and reduced responsiveness. Secondary outcomes include adverse events, recovery time, and endoscopist satisfaction. Adverse events, such as hypotension, tachycardia, bradycardia, and hypoxia, will be recorded using pre-defined criteria for each. Recovery will be assessed every 10 minutes post-procedure using the Aldrete score, with a score of 10 indicating full recovery, after which patients can be discharged. Both patient and endoscopist satisfaction will be measured on a scale of 0 to 5 using Likert scale. This comprehensive approach aims to determine the efficacy, safety, and patient/endoscopist experience associated with the three sedative regimens during colonoscopy
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Double (Participant, Care Provider)
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adults aged 18-60 years
- •Both Genders
- •Indication of colonoscopy procedure without advanced intervention
- •American Society of Anesthesiologists (ASA) physical status I or II
- •Competent to give informed consent
排除标准
- •Personal history of allergic reaction or other contra-indications to midazolam, propofol or fentanyl
- •Age below 18 or above 60 years
- •Chronic use of benzodiazepines
- •ASA physical status III or above
- •Pregnancy
- •History of smoking or alcohol abuse
- •Body mass index > 35 kg/m2
- •History of airway obstruction or difficult intubation
研究组 & 干预措施
Midazolam + Fentanyl
Midazolam AND Fentanyl Before start of colonoscopy procedure patient will be sedated with these drugs in this group. Doses: Midazolam: Initial dose 0.5-1 mg. Additional doses: 1 mg every 2-3 min depending sedation level, maximum dose: 6 mg. till completion of the colonoscopy procedure Fentanyl Initial dose: 12.5-75 μg Additional doses: 12.5-50 μg every 2-3 minutes. Maximum dose: 100 ug
干预措施: Midazolam (Drug)
Midazolam + Fentanyl
Midazolam AND Fentanyl Before start of colonoscopy procedure patient will be sedated with these drugs in this group. Doses: Midazolam: Initial dose 0.5-1 mg. Additional doses: 1 mg every 2-3 min depending sedation level, maximum dose: 6 mg. till completion of the colonoscopy procedure Fentanyl Initial dose: 12.5-75 μg Additional doses: 12.5-50 μg every 2-3 minutes. Maximum dose: 100 ug
干预措施: Fentanyl (Drug)
Propofol
Propofol Before start of colonoscopy procedure patient will be sedated with propofol in this group. Dose:induction dose of 20-50 mg followed by intermittent boluses of 10-20 mg according to the patient response. Maximum total dose of 200 mg. Till completion of the colonoscopy
干预措施: Propofol (Drug)
Propofol +Fentanyl
Propofol AND Fentanyl Before start of colonoscopy procedure patient will be sedated with these drugs in this group. Doses: Propofol: Induction dose of 20-50 mg followed by intermittent boluses of 10-20 mg according to the patient response. maximum total dose of 200 mg. Till completion of the colonoscopy procedure.
Fentanyl Initial dose: 12.5-75 μg Additional doses: 12.5-50 μg every 2-3 minutes. Maximum dose: 100 ug. Till completion of the colonoscopy procedure
干预措施: Propofol (Drug)
Propofol +Fentanyl
Propofol AND Fentanyl Before start of colonoscopy procedure patient will be sedated with these drugs in this group. Doses: Propofol: Induction dose of 20-50 mg followed by intermittent boluses of 10-20 mg according to the patient response. maximum total dose of 200 mg. Till completion of the colonoscopy procedure.
Fentanyl Initial dose: 12.5-75 μg Additional doses: 12.5-50 μg every 2-3 minutes. Maximum dose: 100 ug. Till completion of the colonoscopy procedure
干预措施: Fentanyl (Drug)
结局指标
主要结局
Degree of sedation
时间窗: every 3 minutes till the end of procedure
The degree of sedation shows the depth of sedation. It will be measured by the Observer's assessment of alertness/sedation scale with a minimum and maximum value of 1 and 5 reflecting depth of sedation. Where score 1 means deeply sedated while score 5 means fully awake. Higher scores means not enough sedation.
Onset of sedation
时间窗: It will be measured every 1 minute till 20 minutes.
Onset of sedation means how rapidly patient is sedated after giving the sedative medication. if after 20 minutes, patient not sedated then it will be considered failed to sedate.
Adverse events and complication
时间窗: Monitored continuously during procedure and post procedure for 2 hours and then up to 48 hours after discharge on telephone
Adverse events are any unintended or undesirable clinical occurrences that arise during or after a medical procedure, treatment, or intervention. These events may be related to the procedure itself, the medications administered. These may include hypotension, bradycardia, tachycardia, hypoxia, oversedation leading to respiratory suppression
次要结局
- Patient's satisfaction with the procedure(2 hours from the start of the procedure.)
- procedure completion rate(Decision for procedure completion successfully or not will be at 1 hour. Procedure completion rate at 6 months)
研究者
Mohammed Saud Alsulaimi
Consultant gastroenterology
Qassim Health Cluster