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AgingNCT02857153

Effect of High vs. Low MAP Levels on Clinical Outcomes in Elderly Patients During Noncardiothoracic Surgery

A study testing Urapidil, Phenylephrine and Low-level MAP in people with Aging and Surgery, run by Hu Anmin at 7 sites in China.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This will be a multicentre, randomised, controlled and prospective clinical trial. All participants provided their written informed consent to participate in a randomized trial that examined the effects of low-level MAP (60-70 mmHg) vs. Read more about this study

Who is it for?
Ages 65 years and older
Conditions the study is for
Aging, Surgery, Blood Pressure
What is being tested?
Urapidil, Phenylephrine and Low-level MAP
Could I receive a placebo?
No, everyone receives an active treatment
How many people
322 participants
Where
7 sitesChina
Study dates
Jul 2016to Oct 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 65 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • male and females, American Society of Anesthesiologists I-II-III, 65 or more years of age, scheduled to undergo noncardiothoracic surgery with general anesthesia are enrolled.

Who cannot join

  • the patient suffered from Cardiovascular Disease and Metabolic Diseases, such as hypertension, cardiac disease, diabetes;
  • the patient has severe liver, kidney or blood disease;
  • the patient is accompanied severe cognitive impairment (Mini-Mental State Examination (MMSE) score < 15);
  • preoperative history of schizophrenia, epilepsy, parkinsonism, use of cholinesterase inhibitor, or levodopa treatment;
  • use of haloperidol or other neuroleptics during or after anesthesia;
  • neurosurgery;
  • individuals unlikely to survive for >24 hrs; previous participation in this study.

Trial locations and contacts

7 sites in 1 country.

7 sites in 1 country

China7 sites, 7 recruiting
  • West China Hospital affiliated to Sichuan University

    Chengdu, Sichuan, 610000

    Qiu Yan, M.S, 18980606269, 12395299@qq.com

    Recruiting
  • Sichuan Provincial People's Hospital

    Chengdu, Sichuan, 641000

    Zhang Peng, Ph.D, 15902891950, 583559085@qq.com

    Recruiting
  • The affiliated Hospital of Guizhou Medical University

    Guiyang, Guizhou, 550000

    Hu Bolong, M.S, 375896605@qq.com

    Recruiting
  • The Third Affiliated Hospital of Kunming Medical University

    Kunming, Yunnan, 650000

    Zhao Rui, M.S, 18388231643, 635741914@qq.com

    Recruiting
  • Shenzhen People's Hospital

    Shenzhen, Guangdong, 518001

    Hu Anmin, M.S, 18026980789, toanmin@163.com

    Gong Xiaolei, M.S

    Recruiting
  • Taihe Hospital affiliated to Hubei University of Medicine

    Shiyan, Hubei, 442000

    Wang Xianyu, M.D, 13972482018, wxytj@126.com

    Li Shutao, M.D

    Recruiting
  • Henan Provincial People's Hospital

    Zhengzhou, Henan, 450000

    Yang Yali, M.S, 18703818071, yangyali_1982@163.com

    Recruiting

Other trials in China

About this study

Official title: Comparsion of the Effect of High Versus Low Mean Arterial Pressure (MAP) Levels on Clinical Outcomes in Elderly Patients During Noncardiothoracic Surgery Under General Anesthesia

This will be a multicentre, randomised, controlled and prospective clinical trial. All participants provided their written informed consent to participate in a randomized trial that examined the effects of low-level MAP (60-70 mmHg) vs. high-level MAP (90-100 mmHg) in elderly patients (65 or more years of age) during noncardiothoracic surgery under general anesthesia. The investigators hypothesise high-level blood presure of the intervention for reducing the incidence of post-operative complications.

Read the detailed description

This will be a multicentre, randomised, controlled and prospective clinical trial. Elderly patients will be included from seven centers, including Shenzhen People's Hospital affiliated to Jinan University, West China Hospital affiliated to Sichuan University, Taihe Hospital affiliated to Hubei University of Medicine, The Third Affiliated Hospital of Kunming Medical University, Sichuan Provincial People's Hospital, Guizhou Provincial People's Hospital and Henan Provincial People's Hospital. This research protocol was approved by the Institutional Review Board of Jinan University (2016001).

On the day of surgery, patients come to the operating room and are provided with standard monitoring. General anesthesia is given using midazolam and propofol, opioids, muscle relaxants and maintained with sevoflurane with inhaled concentrations of 1.5% sevoflurane in oxygen. Supplemental dosing of 1 μg/kg of fentanyl is used every hour from induction up to approximately 1 hour prior to the end of surgery. A tramadol bolus of 2 mg/kg is given 15 to 30 mins before the end of surgery. Propofol infusion is stopped 5 to 10 mins prior to the end of surgery, whereas at the end of skin closure, remifentanil was discontinued.

According to grouping, MAP is regulated to the goal level (60-70 mmHg or 95-100 mmHg) during general anesthesia. If necessary, intravenous antihypertensives (urapidil or phenylephrine when mean arterial pressure exceeded 10 mmHg of the target value), rather than more anesthesia, may be used in situations wherein sympathetic stimulation was high; yet a sufficient amount of anesthesia was being administered and bispectral index showed an adequate depth of hypnosis. Sedation was provided by a propofol infusion targeted to a BIS number of approximately 50 during general anesthesia. Atropine and esmolol would be used at the time of heart rate <50 beats/min and >110 beats/min, respectively.

Lactated Ringer's solution was given to bring the maintenance fluids to 10 ml/kg/h. Blood loss could be corrected for in a 1:1 ratio using gelofusine. Hospital transfusion guidelines were used to determine whether blood products were necessary (haemoglobin level less than 10 g/dl in patients with cardiac comorbidities, and below 7 g.dl-1 in those without cardiac disease). For later starting cases, an additional bolus of Ringer's solution of 1.5 ml/kg/fasted hour from 8 AM was given to bring the total 2 ml/kg/fasted hour. If urine output decreased to <0.5 mL/kg/h for 1 hour, fursemide 0.3 mg/kg was given.

Mechanical ventilation patterns are adjusted to obtain an end-tidal carbon dioxide value of 35-45 mmHg, at 5-10 min after induction of anesthesia.

For patients with endotracheal tubes, intravenous sedatives including propofol or midazolam were administrated continuously and titrated by bedside nurses to a target sedation level. Daily awakening is used for those who were not extubated in the morning.

All patients receive patient controlled intravenous analgesia during postoperative days 1 to 3.

Being tested
Urapidil, Phenylephrine, Low-level MAP, High-level MAP
Keywords
MAP, Blood loss, Postoperative delirium, Elderly patients, Noncardiothoracic surgery
Medical subject headings
Blood Loss, Surgical, Emergence Delirium, Hemorrhage

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • UrapidilDrug

    Also called Ebrantil

    If necessary, intravenous urapidil 0.2-0.5 mg/kg when mean arterial pressure exceeded 10 mmHg of the target value, rather than more anesthesia, may be used in situations wherein sympathetic stimulation was high; yet a sufficient amount of anesthesia was being administered and bispectral index showed an adequate depth of hypnosis. Sedation was provided by a propofol infusion targeted to a BIS number of approximately 50 during general anesthesia.

  • PhenylephrineDrug

    Also called Metaoxedrin, Neosynephrine

    If necessary, intravenous phenylephrine 4-6 μg/kg when mean arterial pressure exceeded 10 mmHg of the target value, rather than more anesthesia, may be used in situations wherein sympathetic stimulation was high; yet a sufficient amount of anesthesia was being administered and bispectral index showed an adequate depth of hypnosis. Sedation was provided by a propofol infusion targeted to a BIS number of approximately 50 during general anesthesia.

  • Low-level MAPProcedure or surgery

    MAP is regulated to the goal level (60-70 mmHg) during general anesthesia.

  • High-level MAPProcedure or surgery

    MAP is regulated to the goal level (90-100 mmHg) during general anesthesia.

Study groups in NCT02857153
Study groupRoleWhat they receive
Low-level MAPExperimentalAccording to grouping, MAP is regulated to the goal level (60-70 mmHg) during general anesthesia.
Receives: Drug: Urapidil; Drug: Phenylephrine; Procedure: Low-level MAP
High-level MAPExperimentalAccording to grouping, MAP is regulated to the goal level (90-100 mmHg) during general anesthesia.
Receives: Drug: Urapidil; Drug: Phenylephrine; Procedure: High-level MAP

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of delirium

    Measured: Within the first 7 days after surgery

Secondary outcomes (4)
  1. Delirium duration days (Postoperative delirium defined by the confusion assessment method for the ICU (CAM-ICU))

    Measured: Within the first 7 days after surgery

  2. Intra-operative blood loss

    Estimate of blood loss occurring during the surgical procedure as determined by anesthesia staff and documented by anesthesia, nursing and surgical staff as per hospital protocol.

    Measured: Intra-operative

  3. Intraoperative urine volume.

    Measured: Intra-operative

  4. All-cause 28-day mortality.

    Outcome assessment will be performed by independent researchers.

    Measured: The investigators would observe it within the 28-day period after surgery.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Aug 2016 (estimated)
  2. Study startJul 2016
  3. Primary completionJul 2017 (estimated)
  4. Study completionOct 2017 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
322 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02857153
Sponsor's protocol ID
2016001
Status last verified
Aug 2016
First submitted
15 Jul 2016
Last updated
16 Aug 2016
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Undecided

Publications

  • London MJ. Intraoperative Mean Blood Pressure and Outcome: Is 80 (mmHg) the "New" 60? Anesthesiology. 2016 Jan;124(1):4-6. doi: 10.1097/ALN.0000000000000923. No abstract available.

    PubMed 26540150
  • Monk TG, Bronsert MR, Henderson WG, Mangione MP, Sum-Ping ST, Bentt DR, Nguyen JD, Richman JS, Meguid RA, Hammermeister KE. Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery. Anesthesiology. 2015 Aug;123(2):307-19. doi: 10.1097/ALN.0000000000000756.

    PubMed 26083768
  • Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013 Sep;119(3):507-15. doi: 10.1097/ALN.0b013e3182a10e26.

    PubMed 23835589
  • Chang HS, Hongo K, Nakagawa H. Adverse effects of limited hypotensive anesthesia on the outcome of patients with subarachnoid hemorrhage. J Neurosurg. 2000 Jun;92(6):971-5. doi: 10.3171/jns.2000.92.6.0971.

    PubMed 10839257
  • Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg. 2002 Aug;95(2):273-7, table of contents. doi: 10.1097/00000539-200208000-00003.

    PubMed 12145033
  • Hu A, Qiu Y, Zhang P, Hu B, Yang Y, Li S, Zhao R, Zhang Z, Zhang Y, Zheng Z, Qiu C, Li F, Gong X. Comparison of the effect of high versus low mean arterial pressure levels on clinical outcomes and complications in elderly patients during non-cardiothoracic surgery under general anesthesia: study protocol for a randomized controlled trial. Trials. 2017 Nov 21;18(1):554. doi: 10.1186/s13063-017-2233-8.

    PubMed 29162132

Questions about this trial

What is this clinical trial studying?

A study testing Urapidil, Phenylephrine and Low-level MAP in people with Aging and Surgery, run by Hu Anmin at 7 sites in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 16 Aug 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Hu Anmin (18026980789, toanmin@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of delirium (time frame: Within the first 7 days after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02857153, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Aug 2016.

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