Determination of the 90% Effective Dose (ED90) of Tegileridine Fumarate for Inhibiting Hemodynamic Stress Response Induced by Tracheal Intubation During General Anesthesia: A Biased Coin Up-and-Down Sequential Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 108
- 试验地点
- 1
- 主要终点
- ED90 to suppress hemodynamic response of tracheal intubation
研究概览
简要总结
General anesthesia tracheal intubation causes sympathetic activation and hemodynamic stress response, which increases perioperative cardiovascular risk, especially in elderly subjects. Tegileridine fumarate is a novel μ-opioid receptor G protein-biased agonist. However, the optimal dose of tegileridine to suppress intubation-induced hemodynamic fluctuations during anesthesia induction remains unclear.
This is an open-label, single-center, age-stratified biased coin up-and-down sequential trial. Subjects undergoing elective surgery requiring tracheal intubation will be divided into young adult group (18-64 years) and elderly group (≥65 years). The primary objective is to determine the ED90 of intravenous tegileridine for inhibiting hemodynamic response to tracheal intubation using centered isotonic regression. Secondary outcomes include investigational-drug adverse events, serial hemodynamic parameters. This study will provide evidence for rational dosing of tegileridine in clinical anesthesia induction.
详细描述
Tracheal intubation under general anesthesia stimulates the airway and triggers transient hypertension and tachycardia due to sympathetic excitation. Excessive hemodynamic fluctuations may trigger myocardial ischemia, arrhythmia and other adverse cardiovascular events. Traditional opioids simultaneously activate G-protein and β-arrestin pathways, often accompanied by obvious respiratory depression. As a newly marketed biased μ-opioid agonist, tegileridine exerts analgesic effects with reduced β-arrestin related side effects. Up to now, few studies have explored the effective dose of tegileridine for blunting intubation stress.
We conduct a single-center, open-label sequential dose-finding trial stratified by age. Eligible subjects are ASA I-III patients scheduled for elective surgery with tracheal intubation. Subjects receive intravenous tegileridine before anesthetic induction. The dose is adjusted according to biased coin up-and-down rule based on whether a positive cardiovascular response occurs after intubation. We adopt centered isotonic regression to calculate the 90% effective dose (ED90). Blood pressure, heart rate, investigational-drug adverse reactions will be recorded.The findings of this trial will establish a dosing reference of tegileridine for anesthesia induction and facilitate safer perioperative management.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 90 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •American Society of Anesthesiologists (ASA) physical status I-III
- •Aged ≥18 ears old
- •Scheduled for elective surgery requiring general anesthesia with tracheal intubation
排除标准
- •Resting Systolic Blood Pressure ≥ 160 mmHg, Diastolic Blood Pressure ≥ 110 mmHg, or heart rate ≥ 110 beats/min on admission to operation room
- •Continuous opioid medication use for more than 2 weeks within 6 months before the procedure
- •Known hypersensitivity or allergic reaction to tegileridine, propofol or any excipients of the two drugs
- •Diagnosed psychiatric disorders or inability to communicate and cooperate with study assessment
- •Anticipated difficult airway
研究组 & 干预措施
Intervention Arm
All enrolled subjects receive intravenous tegileridine before anesthesia induction. The dose of tegileridine is adjusted sequentially for each subsequent subject following the biased coin up-and-down rule. General anesthesia and tracheal intubation are performed according to standardized protocol.
干预措施: Tegileridine (Drug)
结局指标
主要结局
ED90 to suppress hemodynamic response of tracheal intubation
时间窗: Within 3 minutes after tracheal intubation
Successful suppression of hemodynamic response is defined as a maximum increase in hemodynamic variables ≤20% from baseline within 3 minutes after tracheal intubation. Centered isotonic regression will be used to calculate the ED₉₀ of tegileridine.
次要结局
- Number of subjects with cough during the study drug (tegileridine) administration and observation period.(From the start of tegileridine injection until 2 minutes after completion of injection.)
研究者
Shiyou Wei
Attending Physician, Department of Anesthesiology
Shanghai Pulmonary Hospital, Shanghai, China