The Effect of Remifentanil and Midazolam on Propofol for Loss of Consciousness During Induction of Anesthesia
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 120
- 试验地点
- 1
- 主要终点
- Loss of verbal response and eyelash reflex
研究概览
简要总结
Propofol in combination with remifentanil or midazolam can result in synergistic or additive effect.
The patients who are scheduled to undergo general anesthesia are enrolled in this study. 120 patients will be randomly allocated to 3 groups(P, PR, PMR). The patients in group P will receive general anesthesia only with propofol and group PR and PMR will receive 0.25 mcg/kg/min remifentanil infusion prior to propofol. The patients in group PMR will receive 0.03 mg/kg bolus dose of midazolam 1 min after start of the remifentanil infusion. 'Success' is defined as loss of both verbal response and eyelash reflex in 2 min after propofol administration. When 'success', the next patient will receive the same dose(in 18/19 probability) or 0.25 mg/kg lower dose(in 1/19 probability) of propofol. When 'failure', the next patient will receive 0.25 mg/kg higher dose of propofol at induction period.
详细描述
Propofol is a well-known induction agent which can provide sound and quick hypnosis with anti-emetic effects. However, dose dependent hypotension or bradycardia have reported while using this agent. Propofol in combination with remifentanil or midazolam can result in synergistic or additive effect. There are not many studies which provide minimum dose of propofol to induce hypnosis in combination with these agents and advantage of the combination.
The patients who are scheduled to undergo general anesthesia are enrolled in this study. 120 patients will be randomly allocated to 3 groups(P, PR, PMR). Sample size have been decided due to the previous studies which have mentioned 40 participants as a adequate sample size for this biased coin design - up and down study.
After receiving informed consent, patients will be participated in this study. No premedication will be given to the patients before induction. The patients in group P will receive general anesthesia only with propofol and group PR and PMR will receive 0.25 mcg/kg/min remifentanil infusion for 5 min prior to propofol administration. The patients in group PMR will receive 0.03 mg/kg bolus dose of midazolam 1 min after the start of the remifentanil infusion. Initial propofol dose will be 1 mg/kg in each group and the dose will be changed by the result of prior study participant.
'Success' of this study will be defined as loss of both verbal response and eyelash reflex in 2 min after propofol administration. When 'success', the next patient will receive the same dose(in 18/19 probability) or 0.25 mg/kg lower dose(in 1/19 probability) of propofol. When 'failure', the next patient will receive 0.25 mg/kg higher dose of propofol at induction period.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 盲法
- Double (Participant, Care Provider)
入排标准
- 年龄范围
- 20 Years 至 50 Years（Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •The patients who are scheduled to undergo general anesthesia for a surgery.
排除标准
- •ASA class (American Society of Anesthesiologist physical status classification) II or higher
- •Patients with history of allergy or side effects on propofol, remifentanil, midazolam
- •BMI (body mass index) less than 20 or higher than 30
- •Patients taking sedatives or hypnotic agents.
研究组 & 干预措施
Group P
Induction with propofol bolus. Dose will be started at 1 mg/kg and will be adjusted as described in summary.
干预措施: Propofol (Drug)
Group PR
Induction with propofol and remifentanil. Remifentanil infusion 0.25 mcg/kg/min for 5 min followed by propofol bolus Propofol dose will be started at 1 mg/kg and will be adjusted as described in summary.
干预措施: Propofol (Drug)
Group PR
Induction with propofol and remifentanil. Remifentanil infusion 0.25 mcg/kg/min for 5 min followed by propofol bolus Propofol dose will be started at 1 mg/kg and will be adjusted as described in summary.
干预措施: Remifentanil (Drug)
Group PMR
Induction with propofol, midazolam and remifentanil. Remifentanil infusion 0.25 mcg/kg/min for 5 min followed by midazolam 0.03 mg/kg bolus 1 min after remifentanil infusion start and propofol bolus administration.
Propofol dose will be started at 1 mg/kg and will be adjusted as described in summary.
干预措施: Propofol (Drug)
Group PMR
Induction with propofol, midazolam and remifentanil. Remifentanil infusion 0.25 mcg/kg/min for 5 min followed by midazolam 0.03 mg/kg bolus 1 min after remifentanil infusion start and propofol bolus administration.
Propofol dose will be started at 1 mg/kg and will be adjusted as described in summary.
干预措施: Remifentanil (Drug)
Group PMR
Induction with propofol, midazolam and remifentanil. Remifentanil infusion 0.25 mcg/kg/min for 5 min followed by midazolam 0.03 mg/kg bolus 1 min after remifentanil infusion start and propofol bolus administration.
Propofol dose will be started at 1 mg/kg and will be adjusted as described in summary.
干预措施: Midazolam (Drug)
结局指标
主要结局
Loss of verbal response and eyelash reflex
时间窗: 2 minutes after propofol administration
Checking verbal response by verbal stimulation (yes or no) and reflex by palpation of the levator palpebrae (yes or no).
次要结局
- Heart rate(baseline, propofol administration time (Just after finishing monitoring on the patient in P group, 5 minutes after remifentanil infusion start in PR and PMR group), 1 minute and 2 minutes after propofol administration)
- Mean blood pressure(baseline, propofol administration time (Just after finishing monitoring on the patient in P group, 5 minutes after remifentanil infusion start in PR and PMR group), 1 minute and 2 minutes after propofol administration)
研究者
Dr. Koh, Jae Chul, MD
Clinical fellow in department of anesthesiology and pain medicine
Severance Hospital