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Intubation ComplicationPhase 4NCT03031808

Comparison of Two Induction Regimens Using Topical Lidocaine or Muscle Relaxant on Sore Throat and Hemodynamics

A Phase 4 study testing Lidocaine spray (2%), Muscle Relaxant (Rocuronium) and No Muscle relaxant, no Lidocaine in people with Intubation Complication, run by Ostfold Hospital Trust at 1 site in Norway.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

When a surgical procedure is performed under general anesthesia, the Airways are often secured With an endotracheal tube. Some patients experience sore throat thereafter. Studies have shown a reduction of these side effects when by use of muscle relaxants or a lidocain spray prior to the intubation. Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Intubation Complication
What is being tested?
Lidocaine spray (2%), Muscle Relaxant (Rocuronium) and No Muscle relaxant, no Lidocaine
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 siteNorway
Study dates
31 Oct 2017to 31 Dec 2020
Phase
Phase 4
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 18 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Scheduled elective surgery with general anesthesia and planned endotracheal intubation.

Who cannot join

  • ASA≥3,
  • 20>BMI<35
  • Allergy to local anesthetics or neuromuscular blocking agents.
  • The ASA physical status classification system is a system for assessing the fitness of patients before surgery. BMI is Body Mass Index measured in kilograms/square meter.

Trial locations and contacts

1 site in 1 country.

Jan Sverre Vamnes, MD, Ph.D contact

+47 913 05 016

jan.sverre.vamnes@so-hf.no

Knut Inge Solbakk, MD contact

+47 909 33 106

knut.inge.solbakk@so-hf.no

Norway1 site, 1 recruiting
  • Ostfold Hospital Trust, Moss

    Grålum, Østfold fylke, 1714

    Jan Sverre Vamnes, MD, Ph.D., +47 91608896, janvam@so-hf.no

    Knut Inge Solbakk, md, +47 90933106, knisol@so-hf.no

    Recruiting

Other trials in Norway

About this study

Official title: Comparison of Two Induction Regimens Using Topical Lidocaine or Muscle Relaxant; Impact on Postoperative Sore Throat and Haemodynamics

When a surgical procedure is performed under general anesthesia, the Airways are often secured With an endotracheal tube. Some patients experience sore throat thereafter. Studies have shown a reduction of these side effects when by use of muscle relaxants or a lidocain spray prior to the intubation. At Ostfold Hospital Trust, the investigators use one of the two methods or nothing. These methods will be studied systematically.

Heart rate and blood pressure rise during the intubation procedure. The investigators will also study the differences between the groups.

Read the detailed description

Post-operative sore throat and cough are common complications of endotracheal intubation and occurs in 30% to 70% of patients. Spraying with Lidocaine reduces this incident of postoperative sore Throat (POST). The use of neuromuscular blocking agents (NMBA) alone will also diminish the incidence of adverse postoperative upper airway symptoms. The use of topical Lidocaine is shown to reduce the cardiovascular responses during and after endotracheal intubation.

Hypertension and tachycardia as a response to endotracheal intubation are probably of little consequence in healthy individuals. These reactions might though be harmful in patients with cardiovascular diseases.

Postoperative sore throat is an undesired outcome for the patient. Topical or systemic pharmacological interventions is shown to reduce the POST.

Our anesthetists practice very different. The investigators sometime use topical lidocaine 2% as a spray, sometime muscle relaxants and often nothing but propofol and remifentanil prior to laryngoscopy an endotracheal intubation.

The objective of this study is to determine, whether the use of topical administered lidocaine, 2 %, has a better impact on POST compared with NMBA alone in general anesthesia with propofol and remifentanil. Patients receiving nothing but propofol and remifentanil will be the reference group. Assessment of the intubation conditions will be done according to a standard scheme

The primary endpoint:

  • Differences in the intubation conditions between the three groups.
  • Cardiovascular responses caused by the laryngoscopy and intubation.

The secondary endpoint:

  • Post operative upper airways symptoms. Power and Sample Size Calculator To detect a decrease in the incidence of pharyngolaryngeal symptoms from 60% to 45%, we calculated that we needed 150 patients per study arm (power of the study, 0,8; type I error, 0,05).

450 adult patients have to be scheduled for the study.

The study is double blind, randomized:

  • Group Topical lidocaine 4%:
  • Group NMBA
  • Control group Premedication: Paracetamol 2g General anaesthesia: TCI (Target Control of Infusion is a principle, an anesthesia infusion after protocol): Propofol and Remifentanil Surgical procedure: Not specified short lasting (<1 h) procedures The experienced anesthesiologist performing the intubating procedure will not be in the room until immediately before the intubation.

Postoperatively:

  • Oral paracetamol and codeine-fixed combination up to 1000 mg and 60 mg, respectively, every 6 h
  • When nausea and vomiting occurs postoperatively, ondansetron 4 mg IV administers as the drug of first choice followed by droperidol 0,625 mg IV if the nausea/vomiting persists.

Collected data:

  • Patient characteristics inclusive smoke habits
  • Intubation conditions according to the Copenhagen score
  • Blood pressure prior to laryngoscopy and after 1, 3, 5, 7, 9, 11, 13 and 15 minutes, then every 15 min.
  • Cuff pressure
  • Pharyngolaryngeal discomfort 2 and 24 hours (telephone interview if released from hospital) after extubation
Being tested
Lidocaine spray (2%), Muscle Relaxant (Rocuronium), No Muscle relaxant, no Lidocaine

What participants receive

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

  • Lidocaine spray (2%)Drug

    Also called Xylocain 2% Astra Zeneca

    Spraying trachea from 2 cm above the vocal cords and 5 cm down with a straw with multiple side holes

  • Muscle Relaxant (Rocuronium)Drug

    Also called Esmeron MSD

    After induction of anesthesia, the participants are given 0,6 mg/kg bodyweight intravenously.

  • No Muscle relaxant, no LidocaineOther

    Also called Control group

    This group get general anesthesia without Rocuronium or Lidocaine

Study groups in NCT03031808
Study groupRoleWhat they receive
Lidocaine sprayOtherEndotracheal lidocaine spray prior to intubation
Receives: Drug: Lidocaine spray (2%)
Muscle relaxantOtherMuscle relaxant prior to intubation
Receives: Drug: Muscle Relaxant (Rocuronium)
No Muscle relaxant, no LidocaineOther'No Muscle relaxant, no Lidocaine Control group
Receives: Other: No Muscle relaxant, no Lidocaine

What is being measured

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

  1. Sore Throat postoperative. Assessment of complaints and changes in complaints

    Postoperative sore throat, described 2 h and 24 h after extubation. If the patient has sore throat or is hoarse, the complaint is assessed on a VAS (Visual Analogue Scale) 1 - 10.

    Measured: 2 h and 24 h after extubation

  2. Intubation conditions directly after induction of anesthesia

    Describes the intubation conditions: Jaw relaxation, resistance to laryngoscopy blade, the position and movement of vocal cords, the movement of limbs and coughing. Each variable rates as excellent, good or poor. Intubation conditions are many variables described once and should not be divided into several outcomes.

    Measured: 90 sec. after established general anesthesia

  3. Hemodynamic parameters, change in HR (Heart Rate) is being assessed

    Describes changes in HR (Heart Rate)

    Measured: Prior to induction, then every second minute the next 15 minutes, thereafter every 15 minute until end of surgery (max. 2 h.)

  4. Hemodynamic parameters, change in BP (blood pressure) is being assessed

    Describes changes in BP(Blood Pressure)

    Measured: Prior to induction, then every second minute the next 15 minutes, thereafter every 15 minute until end of surgery (max. 2 h.)

Timeline

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

  1. First posted26 Jan 2017 (estimated)
  2. Study start31 Oct 2017
  3. Primary completion31 Dec 2020 (estimated)
  4. Study completion31 Dec 2020 (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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03031808
Sponsor's protocol ID
AB3383
Status last verified
Mar 2019
First submitted
21 Dec 2016
Last updated
13 Mar 2019
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: No sharing plan so far.

Publications

  • Banihashem N, Alijanpour E, Hasannasab B, Zarei A. Prophylactic Effects of Lidocaine or Beclomethasone Spray on Post-Operative Sore Throat and Cough after Orotracheal Intubation. Iran J Otorhinolaryngol. 2015 May;27(80):179-84.

    PubMed 26082898
  • Blobner M, Mirakhur RK, Wierda JM, Wright PM, Olkkola KT, Debaene B, Pendeville P, Engbaek J, Rietbergen H, Sparr HJ. Rapacuronium 2.0 or 2.5 mg kg-1 for rapid-sequence induction: comparison with succinylcholine 1.0 mg kg-1. Br J Anaesth. 2000 Nov;85(5):724-31. doi: 10.1093/bja/85.5.724.

    PubMed 11094588
  • Combes X, Andriamifidy L, Dufresne E, Suen P, Sauvat S, Scherrer E, Feiss P, Marty J, Duvaldestin P. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007 Aug;99(2):276-81. doi: 10.1093/bja/aem147. Epub 2007 Jun 15.

    PubMed 17573390
  • Domaoal AM, Weniger FC, Wolfson B. "Precurarization" using pancuronium. Anesth Analg. 1975 Jan-Feb;54(1):71-5. doi: 10.1213/00000539-197501000-00014.

    PubMed 1167764
  • Doyle DJ. Airway anesthesia: theory and practice. Anesthesiol Clin. 2015 Jun;33(2):291-304. doi: 10.1016/j.anclin.2015.02.013.

    PubMed 25999003
  • Kalil DM, Silvestro LS, Austin PN. Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation. AANA J. 2014 Jun;82(3):188-97.

    PubMed 25109156
  • Martin C, Bonneru JJ, Brun JP, Albanese J, Gouin F. Vecuronium or suxamethonium for rapid sequence intubation: which is better? Br J Anaesth. 1987 Oct;59(10):1240-4. doi: 10.1093/bja/59.10.1240.

    PubMed 2890365
  • Mostafa SM, Murthy BV, Barrett PJ, McHugh P. Comparison of the effects of topical lignocaine spray applied before or after induction of anaesthesia on the pressor response to direct laryngoscopy and intubation. Eur J Anaesthesiol. 1999 Jan;16(1):7-10. doi: 10.1046/j.1365-2346.1999.00410.x.

    PubMed 10084094
  • Koller ME, Husby P. High-dose vecuronium may be an alternative to suxamethonium for rapid-sequence intubation. Acta Anaesthesiol Scand. 1993 Jul;37(5):465-8. doi: 10.1111/j.1399-6576.1993.tb03747.x.

    PubMed 7741805
  • Qi DY, Wang K, Zhang H, Du BX, Xu FY, Wang L, Zou Z, Shi XY. Efficacy of intravenous lidocaine versus placebo on attenuating cardiovascular response to laryngoscopy and tracheal intubation: a systematic review of randomized controlled trials. Minerva Anestesiol. 2013 Dec;79(12):1423-35. Epub 2013 Jul 9.

    PubMed 23839320
  • Tanaka Y, Nakayama T, Nishimori M, Sato Y, Furuya H. Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD004081. doi: 10.1002/14651858.CD004081.pub2.

    PubMed 19588349
  • Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, Koscielniak-Nielsen Z, Skovgaard LT, Ostergaard D. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996 Jan;40(1):59-74. doi: 10.1111/j.1399-6576.1996.tb04389.x.

    PubMed 8904261

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Lidocaine spray (2%), Muscle Relaxant (Rocuronium) and No Muscle relaxant, no Lidocaine in people with Intubation Complication, run by Ostfold Hospital Trust at 1 site in Norway.

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 4 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 13 Mar 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Norway. 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.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

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 Jan Sverre Vamnes, MD, Ph.D (+47 913 05 016, jan.sverre.vamnes@so-hf.no), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Sore Throat postoperative. Assessment of complaints and changes in complaints (time frame: 2 h and 24 h after extubation). The study lists 4 primary outcomes in all. 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 NCT03031808, which also lists 12 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 13 Mar 2019.

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