A Randomized Comparison of Midazolam With Meperidine and Dexmedetomidine Versus Midazolam With Meperidine and Propofol for Sedation During ERCP
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 入组人数
- 258
- 试验地点
- 1
- 主要终点
- the rates of cardiopulmonary complications
研究概览
简要总结
This is a single-center, prospective, randomized, double-blinded study of consecutive patients referred for ERCP. A recent study suggested that the addition of dexmedetomidine to the midazolam-meperidine regimen (MMD)provided better sedative efficacy and a superior safety profile during ERCP compared with a midazolam-meperidine regimen. Further study is warranted to compare an MMD regimen with propofol-based regimen.
Randomization is performed by use of a computer-generated random allocations in a ratio of 1:1 in balanced blocks of 4. A separate sedating nurse, who don't participate in the study, is the only person with knowledge of the sedation regimen. This separate nurse repeated the injection of propofol and completed questionnaires.
详细描述
Study design This is a single-center, prospective, randomized, double-blinded study of consecutive patients referred for ERCP. Randomization is performed by use of a computer-generated random allocations in a ratio of 1:1 in balanced blocks of 4. A separate sedating nurse, who don't participate in the study, is the only person with knowledge of the sedation regimen. This separate nurse repeated the injection of propofol and completed questionnaires.
Inclusion criteria include consecutive patients who are scheduled for ERCP and those are aged 18-80 years. (ASA class I-III) Exclusion criteria are as follows;
- patient age < 18years, 2) pregnancy, 3) American Society of Anesthesiology (ASA) physical status class IV, V, 4) history of allergies to drug used, 6) history of complications with previous sedation, 5) hypoxemia (baseline SaO2) <90%, 6) hypotension (baseline systolic blood pressure <90mmHg), 7) severe bradycardia (heart rate <50/min) and/or brady-dysrhythmias (e.g. advanced heart block), 8) impaired ventricular function (left ventricular ejection fraction <30%), 9) baseline respiratory rate >25 or <10 breaths/min, and 10) inability to provide informed consent. Patients are excluded from the final analysis if the procedure is terminated early or abandoned for anatomical reasons (i.e., duodenal obstruction or gastrectomy).
Sedation protocols After randomization patients are allocated to group 1 or 2, and prepared for endoscopy.
All sedatives and analgesics used for the study are administered by trained sedative nurse under endoscopist supervision. All participants receive an IV bolus dose of midazolam (0.06mg/kg, 50% reduction for patients if age ≥70 or ASA class III-IV; Bukwang Pharm Co., Seoul, Republic of Korea) and meperidine (50mg. 25mg for patients aged ≥70 years; pethidine HCL, Hana Pharm Co., Seoul, Republic of Korea). Repeated doses of 10-20 mg propofol are titrated to achieve the target level of sedation. Maintenance of sedation is achieved with repeated doses of 5 to 20 mg propofol. The total dosage of propofol (including additional doses) is limited by lower and upper bounds of 10mg and 100mg, respectively. The target level of sedation is moderate sedation based on the ASA levels.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Those who are scheduled for ERCPs
- •aged 18 to 80 years
- •American Society of Anesthesiologists (ASA) classification I to III
排除标准
- •ASA IV and V
- •History of allergies to drug used
- •refuse to participate the study
研究组 & 干预措施
MMD arm
Both midazolam® (0.05 mg/kg, 30% reduction for patients if age ≥70 or ASA class III-IV; Bukwang Pharm Co., Seoul, Republic of Korea) and meperidine (50mg. 25mg for patients aged ≥70 years; pethidine HCL, Hana Pharm Co., Seoul, Republic of Korea) are given intravenously at the initiation of sedation. In addition, a continuous IV infusion of dexmedetomidine (1ug/kg/h, Precedex; Hospira, Seoul, Republic of Korea) is administered 15 min before the ERCP till complete procedure
干预措施: Midazolam® (Drug)
MMD arm
Both midazolam® (0.05 mg/kg, 30% reduction for patients if age ≥70 or ASA class III-IV; Bukwang Pharm Co., Seoul, Republic of Korea) and meperidine (50mg. 25mg for patients aged ≥70 years; pethidine HCL, Hana Pharm Co., Seoul, Republic of Korea) are given intravenously at the initiation of sedation. In addition, a continuous IV infusion of dexmedetomidine (1ug/kg/h, Precedex; Hospira, Seoul, Republic of Korea) is administered 15 min before the ERCP till complete procedure
干预措施: "Meperidine" (pethidine®) (Drug)
MMD arm
Both midazolam® (0.05 mg/kg, 30% reduction for patients if age ≥70 or ASA class III-IV; Bukwang Pharm Co., Seoul, Republic of Korea) and meperidine (50mg. 25mg for patients aged ≥70 years; pethidine HCL, Hana Pharm Co., Seoul, Republic of Korea) are given intravenously at the initiation of sedation. In addition, a continuous IV infusion of dexmedetomidine (1ug/kg/h, Precedex; Hospira, Seoul, Republic of Korea) is administered 15 min before the ERCP till complete procedure
干预措施: Dexmedetomidine (Precedex®) (Drug)
BPS arm
IV bolus dose of midazolam® (0.06mg/kg, 50% reduction for patients if age ≥70 or ASA class III-IV; Bukwang Pharm Co., Seoul, Republic of Korea) and meperidine (50mg. 25mg for patients aged ≥70 years; pethidine HCL, Hana Pharm Co., Seoul, Republic of Korea). Repeated doses of 10-20 mg propofol® are titrated to achieve the target level of sedation. 0.9% NaCl 1μg/Kg•hr IV continuous infusion, initiated 15 min before the procedure (ERCP) till complete procedure
干预措施: Midazolam® (Drug)
BPS arm
IV bolus dose of midazolam® (0.06mg/kg, 50% reduction for patients if age ≥70 or ASA class III-IV; Bukwang Pharm Co., Seoul, Republic of Korea) and meperidine (50mg. 25mg for patients aged ≥70 years; pethidine HCL, Hana Pharm Co., Seoul, Republic of Korea). Repeated doses of 10-20 mg propofol® are titrated to achieve the target level of sedation. 0.9% NaCl 1μg/Kg•hr IV continuous infusion, initiated 15 min before the procedure (ERCP) till complete procedure
干预措施: "Meperidine" (pethidine®) (Drug)
BPS arm
IV bolus dose of midazolam® (0.06mg/kg, 50% reduction for patients if age ≥70 or ASA class III-IV; Bukwang Pharm Co., Seoul, Republic of Korea) and meperidine (50mg. 25mg for patients aged ≥70 years; pethidine HCL, Hana Pharm Co., Seoul, Republic of Korea). Repeated doses of 10-20 mg propofol® are titrated to achieve the target level of sedation. 0.9% NaCl 1μg/Kg•hr IV continuous infusion, initiated 15 min before the procedure (ERCP) till complete procedure
干预措施: Propofol® (Drug)
结局指标
主要结局
the rates of cardiopulmonary complications
时间窗: From start point of the procedure(ERCP) to 60 minutes after the procedure
respiratory depression (≤10 breaths/min); desaturation (SaO2\<90% with no recovery against a verbal stimulus or jaw extension); hypotension (systolic blood pressure \<90mmHg or 20% reduction from baseline mean blood pressure
次要结局
- Speed of recovery(From start point of the procedure(ERCP) to 1 hour after the procedure)
- Sedation efficacy(From start point of the procedure(ERCP) to 1 hour after the procedure)
- procedural satisfaction(From start point of the procedure(ERCP) to 1 day after the procedure)
研究者
Jun Ho Choi
Assistant professor
Dankook University