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AnesthesiaNCT04904965

Frontal Electroencephalography of Neonatal Patients Under Sedation With Opioids and General Anesthesia With Propofol.

A study testing Propofol Group 1, Propofol Group 2 and Propofol Group 3 in people with Anesthesia and Surgery, run by Pontificia Universidad Catolica de Chile at 1 site in Chile.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Frequently, neonates hospitalized in neonatology units require anesthesia for surgery. The drugs used for this purpose are opioids and other anesthetics, such as propofol. Currently, the administration of anesthesia is difficult in neonates due to the neurological immaturity of these patients, the scarcity of adequate… Read more about this study

Who is it for?
Ages 1 day to 1 month
Conditions the study is for
Anesthesia, Surgery, Neonate
What is being tested?
Propofol Group 1, Propofol Group 2 and Propofol Group 3
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteChile
Study dates
3 May 2021to 3 Mar 2023
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 1 day to 1 month
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Term newborns (>37 weeks) admitted to the NICU
  • Diagnosis of surgical pathology, non-neurological, to be resolved in the NICU, in the next hours or days.
  • Need for continuous sedation-analgesia prior to surgery.

Who cannot join

  • Perinatal asphyxia
  • Evidence of severe neurological injury.
  • Suspected or diagnosed brain malformations
  • Uncontrolled metabolic and hemodynamic instability at the time of surgery.

Trial locations and contacts

1 site in 1 country.

Chile1 site
  • Pontificia Universidad Catolica de Chile

    Santiago, Santiago Metropolitan, 450881

Other trials in Chile

About this study

Frequently, neonates hospitalized in neonatology units require anesthesia for surgery. The drugs used for this purpose are opioids and other anesthetics, such as propofol.

Currently, the administration of anesthesia is difficult in neonates due to the neurological immaturity of these patients, the scarcity of adequate pharmacological studies, the prolonged use of one or more sedatives prior to surgery and the limited usefulness of current anesthetic monitoring devices in this population.

Electroencephalography (EEG), which has allowed estimation of anesthetic depth in other populations, has been less explored in neonates. To date, there are no EEG markers, correlated with a given dose of anesthesia, that allow an adequate administration in this kind of patients. In this context, a better understanding of the anesthetic effect in the neonatal brain would allow defining characteristic EEG patterns, improving the estimation of anesthetic depth and anesthetic dosage in neonates.

Read the detailed description

As a consequence of the cerebral immaturity of newborns (1,2), together with the fact that in the NICU it is common to find patients requiring surgery who are sedated with multiple drugs, it is necessary to define characteristic EEG patterns that allow estimation of the anesthetic depth and adequate dosage of anesthetics, avoiding the the risk of under- or overdosing of anesthetics (3).

The investigators will conduct an exploratory study. The aim of the study is to determine, by frontal electroencephalography, markers of brain electrical activity associated with the administration of propofol in term newborns requiring surgery in the NICU. A sample of 20 term neonatal patients admitted to the NICU UC with a diagnosis of surgical pathology will be included.

General objective:

To describe the characteristics of the frontal electroencephalographic pattern associated with increasing doses of propofol, in term neonates, requiring surgery in the NICU and its correlation with a clinical response, to the surgical stimulus.

Specific objectives:

  • Identify the association between electroencephalographic parameters and different levels of sedation prior to surgery.
  • To identify the association between electroencephalographic parameters and increasing doses (plasma concentration) of propofol administered in a previously sedated patient.
  • To relate the clinical response observed to the surgical stimulus and increasing doses (plasma concentration) of propofol in a previously sedated patient (dose (concentration) - response curve).
  • To describe the temporal profile of propofol anesthesia, based on the changes in electroencephalographic parameters observed over time, during the period of administration and suspension of the anesthetic.

On the scheduled day of surgery in the NICU and prior to anesthetic induction, in sedated and standardly monitored patients (ECG, SpO2, PAI, temperature, diuresis). A four-channel SedLine® monitor (Masimo Corporation, Irvine, CA, USA) will be used to monitor frontal brain electrical activity 10 minutes before the induction of anesthesia. At the end of this period, the level of sedation will be evaluated with the N-PASS clinical scale (4) and the types, doses and duration of sedative drugs administered up to that time will be recorded. Then, patients will be randomized into 4 groups, of 5 patients each, to receive manual total intravenous anesthesia, with different propofol infusion rates: Group 1, Propofol 2.0 mg/kg/hr; Group 2, Propofol 4.0 mg/kg/hr; Group 3, Propofol 6.0 mg/kg/hr; Group 4, Propofol 8.0 mg/kg/hrs. At 10 and 20 minutes after the start of the propofol infusion, arterial blood samples will be taken to determine the plasma concentration of propofol reached during the anesthetic induction. In case of hemodynamic alteration (heart rate and/or blood pressure drop by 20%) during the propofol infusion, a 25% decrease of the original dose will be performed. At the end of this period, surgery will be initiated. The hemodynamic and motor response to the surgical stimulus will be observed and recorded. If there is hemodynamic response (increase in heart rate and/or blood pressure by 20%) and/or motor response, after the surgical stimulus, fentanyl rescue 5 mcg/kg/iv will be administered. Subsequent anesthesia will be in the hands of the treating anesthesiologist in the doses and forms he/she deems convenient. Electroencephalographic tracing will be maintained continuously throughout the procedure (from 10 minutes before and up to 10 minutes after surgery). Changes and adjustments to the anesthesia and analgesia given, hemodynamic changes occurring during the procedure and anesthetic and surgical times will be recorded.

Being tested
Propofol Group 1, Propofol Group 2, Propofol Group 3, Propofol Group 4
Keywords
propofol, neonate, deph of anesthesia, Electroencephalography, surgery

What participants receive

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

  • Propofol Group 1Drug

    Also called Group 1

    Propofol 2.0 mg/kg/hr per 10 min

  • Propofol Group 2Drug

    Also called Group 2

    Propofol 4.0 mg/kg/hr per 10 min

  • Propofol Group 3Drug

    Also called Group 3

    Propofol 6.0 mg/kg/hr per 10 min

  • Propofol Group 4Drug

    Also called Group 4

    Propofol 8.0 mg/kg/hr per 10 min

Study groups in NCT04904965
Study groupRoleWhat they receive
Propofol Group 1ExperimentalPatients will receive induction of anesthesia with Propofol at a rate of 2.0 mg/kg/hr.
Receives: Drug: Propofol Group 1
Propofol Group 2ExperimentalPatients will receive induction of anesthesia with Propofol at a rate of 4.0 mg/kg/hr.
Receives: Drug: Propofol Group 2
Propofol Group 3ExperimentalPatients will receive induction of anesthesia with Propofol at a rate of 6.0 mg/kg/hr.
Receives: Drug: Propofol Group 3
Propofol Group 4ExperimentalPatients will receive induction of anesthesia with Propofol at a rate of 8.0 mg/kg/hr.
Receives: Drug: Propofol Group 4

What is being measured

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

  1. Electroencephalography monitoring slow bands

    Power of frequency slow bands, entropy and complexity measures.

    Measured: 10 minutes before the induction of anesthesia until 10 minutes after emergence of anesthesia, average of 2 hours

  2. Electroencephalography monitoring alpha bands

    Power of frequency alpha bands, entropy and complexity measures.

    Measured: 10 minutes before the induction of anesthesia until 10 minutes after emergence of anesthesia, average of 2 hours

  3. Electroencephalography monitoring Theta bands

    Power of frequency Theta bands, entropy and complexity measures.

    Measured: 10 minutes before the induction of anesthesia until 10 minutes after emergence of anesthesia, average of 2 hours

Secondary outcomes (5)
  1. Arterial Pressure

    By non invasive Arterial Pressure: Systolic Arterial Pressure in mmHg, diastolic Arterial Pressure in mmHg and Medium Arterial Pressure in mmHg, every 5 minutes.

    Measured: From induction of anesthesia until surgery starts, average 20 minutes.

  2. Heart Rate

    By EKG D-II, every 5 minutes.

    Measured: From induction of anesthesia until surgery starts, average 20 minutes.

  3. Depth of anesthesia

    Evaluated with N-PASS clinical scale. The N-PASS uses five criteria: crying/irritability, behavioral state, facial expression, extremity tone and vital signs. The scale has a range from 0 (normal) to -10 (sedated).

    Measured: before the induction of anesthesia until the surgery starts, every 10 minutes. An average of 30 minutes.

  4. Propofol plasma concentration

    Venous or arterial samples will be taken for propofol plasma concentration levels (ng/ml) at two times (10 minutes and 20 minutes from induction of anesthesia).

    Measured: from induction of anesthesia up to 20 minutes.

  5. Motor response to surgical incision

    Presence of any body movement at the moment of the first surgical incision.

    Measured: at first surgical incision (average 1 minute).

Timeline

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

  1. First posted27 May 2021
  2. Study start3 May 2021
  3. Primary completion3 Dec 2022
  4. Study completion3 Mar 2023

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
Diagnosis
Allocation
Randomised
Intervention model
Factorial
Model description
Patients will be randomized into 4 groups, of 5 patients each, to receive total intravenous anesthesia, with different propofol induction infusion rates: Group 1 (Propofol 2.0 mg/kg/hr); Group 2 (Propofol 4.0 mg/kg/hr); Group 3 (Propofol 6.0 mg/kg/hr); Group 4 (Propofol 8.0 mg/kg/hr).
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
20 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04904965
Sponsor's protocol ID
200916011
Status last verified
Mar 2023
First submitted
12 May 2021
Last updated
7 Mar 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Andre M, Lamblin MD, d'Allest AM, Curzi-Dascalova L, Moussalli-Salefranque F, S Nguyen The T, Vecchierini-Blineau MF, Wallois F, Walls-Esquivel E, Plouin P. Electroencephalography in premature and full-term infants. Developmental features and glossary. Neurophysiol Clin. 2010 May;40(2):59-124. doi: 10.1016/j.neucli.2010.02.002. Epub 2010 Mar 16.

    PubMed 20510792
  • Shany E, Berger I. Neonatal electroencephalography: review of a practical approach. J Child Neurol. 2011 Mar;26(3):341-55. doi: 10.1177/0883073810384866.

    PubMed 21383227
  • Anand KJ, Willson DF, Berger J, Harrison R, Meert KL, Zimmerman J, Carcillo J, Newth CJ, Prodhan P, Dean JM, Nicholson C; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics. 2010 May;125(5):e1208-25. doi: 10.1542/peds.2009-0489. Epub 2010 Apr 19.

    PubMed 20403936
  • Giordano V, Edobor J, Deindl P, Wildner B, Goeral K, Steinbauer P, Werther T, Berger A, Olischar M. Pain and Sedation Scales for Neonatal and Pediatric Patients in a Preverbal Stage of Development: A Systematic Review. JAMA Pediatr. 2019 Dec 1;173(12):1186-1197. doi: 10.1001/jamapediatrics.2019.3351.

    PubMed 31609437
  • Boncompte G, Cortinez LI, Toso A, Giordano A, Cruzat F, Fuentes R, Pedemonte JC, Contreras V, Biggs D, Chiu E, Ibacache M. Differential effects of propofol anaesthesia across three amplitude-defined electroencephalographic states in sedated critically ill term neonates: An observational study. Eur J Anaesthesiol. 2025 Oct 1;42(10):889-898. doi: 10.1097/EJA.0000000000002208. Epub 2025 May 23.

    PubMed 40420743

Questions about this trial

What is this clinical trial studying?

A study testing Propofol Group 1, Propofol Group 2 and Propofol Group 3 in people with Anesthesia and Surgery, run by Pontificia Universidad Catolica de Chile at 1 site in Chile.

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 3 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: finished, as of the sponsor's last update on 7 Mar 2023. 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 Chile. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Electroencephalography monitoring slow bands (time frame: 10 minutes before the induction of anesthesia until 10 minutes after emergence of anesthesia, average of 2 hours). The study lists 3 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 NCT04904965, which also lists 5 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 7 Mar 2023.

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