Ignite Creation Date:
2024-05-06 @ 9:20 AM
Last Modification Date:
2024-10-26 @ 12:13 PM
Study NCT ID:
NCT02964416
Status:
COMPLETED
Last Update Posted:
2020-08-04
First Post:
2016-09-19
Brief Title:
Single Dose Tramadol Effect on Extubation Response and Quality of Emergence Post-supratentorial Intracranial Surgery
Sponsor:
Aga Khan University
Organization:
Aga Khan University
Study Overview
Official Title:
Effect of Single Dose of Tramadol on Extubation Response and Quality of EmergenceCough and Nausea Vomiting Following Supratentorial Intracranial Surgery
Status:
COMPLETED
Status Verified Date:
2020-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Several modalities have been studied to prevent coughing during emergence including extubation in a deep plane of anesthesia but have proved to be unreliable So far no reliable method is recommended as standard of care The advantages of administering tramadol includes a long duration of action rapid recovery limited depression of respiratory function and no effect on platelet makes it a safe medication to use for neurosurgical patients after craniotomy The primary objective of the study is to observe the effect of single dose of tramadol 1mgkg administered 45 minutes before extubation on hemodynamic response measurement of BP and HR during extubation
Detailed Description:
Extubation after intracranial tumor surgery is desirable in order to make an early diagnosis of intracranial complications Extubation however may be associated with haemodynamic and metabolic changes eg agitation increased oxygen consumption catecholamine secretion hypercapnia and systemic hypertension
These changes cause cerebral hyperemia intracranial hypertension leading to cerebral oedema or haemorrhage thus it is important to have smooth extubation with minimal haemodynamic and metabolic effects
Incidence of coughing on emergence from general anesthesia ranges from 38 to 96 This may also result in postoperative intracranial hemorrhage intracranial hypertension cerebral edema or intraocular hypertensionThis can be detrimental in neurosurgery
Several modalities have been studied to prevent coughing during emergence including extubation in a deep plane of anesthesia but have proved to be unreliable So far no reliable method is recommended as standard of care
Tramadol a synthetic opioid of the aminocyclohexanes group is a centrally acting opioid analgesic that is used to treat moderate-to-severe pain and has an inhibitory effect on M1 and M3 muscarinic receptors It also reduces the incidence of cough and improves extubation quality and provides more stable haemodynamics during emergence It neither causes respiratory depression nor affects intracranial pressure ICP and cerebral perfusion pressure CPP Other potential advantage of administering tramadol includes a long duration of action rapid recovery limited depression of respiratory function and no effect on platelets thus making it a safe medication to use for neurosurgical patients after craniotomy The onset of effect following a single dose is 3 to 5 minutes with peak effect at 45 minutes
Aim of doing this study is to observe the effect of a single dose of tramadol on quality of tracheal extubation as judged by incidence of coughing and haemodynamic changes at emergence from anesthesia
OBJECTIVE
Primary Objective To observe the effect of single dose of tramadol 1mgkg administered 45 minutes before extubation on haemodynamic response measurement of BP and HR during extubation
Secondary Objective To measure the quality of emergence from general anaesthesia by measuring the frequency of cough laryngospasm and episodes of desaturation
OPERATIONAL DEFINITION
Emergence Period This will be defined as the time from the recovery of spontaneous breathing after giving reversal to tracheal extubation
Quality of emergence Good quality emergence will be defined as extubation not associated with coughing bucking tachycardia hypertension laryngospasm or bronchospasm
Tachycardia and hypertension Rise in heart rate and blood pressure more than 20 from baseline value
Extubation response Physiological response related to blood pressure and heart rate during extubation of trachea is called extubation response
HYPOTHESIS
Tramadol obtunds haemodynamic and cough response to extubation and thus results in good quality emergence after supratentorial craniotomy
These changes cause cerebral hyperemia intracranial hypertension leading to cerebral oedema or haemorrhage thus it is important to have smooth extubation with minimal haemodynamic and metabolic effects
Incidence of coughing on emergence from general anesthesia ranges from 38 to 96 This may also result in postoperative intracranial hemorrhage intracranial hypertension cerebral edema or intraocular hypertensionThis can be detrimental in neurosurgery
Several modalities have been studied to prevent coughing during emergence including extubation in a deep plane of anesthesia but have proved to be unreliable So far no reliable method is recommended as standard of care
Tramadol a synthetic opioid of the aminocyclohexanes group is a centrally acting opioid analgesic that is used to treat moderate-to-severe pain and has an inhibitory effect on M1 and M3 muscarinic receptors It also reduces the incidence of cough and improves extubation quality and provides more stable haemodynamics during emergence It neither causes respiratory depression nor affects intracranial pressure ICP and cerebral perfusion pressure CPP Other potential advantage of administering tramadol includes a long duration of action rapid recovery limited depression of respiratory function and no effect on platelets thus making it a safe medication to use for neurosurgical patients after craniotomy The onset of effect following a single dose is 3 to 5 minutes with peak effect at 45 minutes
Aim of doing this study is to observe the effect of a single dose of tramadol on quality of tracheal extubation as judged by incidence of coughing and haemodynamic changes at emergence from anesthesia
OBJECTIVE
Primary Objective To observe the effect of single dose of tramadol 1mgkg administered 45 minutes before extubation on haemodynamic response measurement of BP and HR during extubation
Secondary Objective To measure the quality of emergence from general anaesthesia by measuring the frequency of cough laryngospasm and episodes of desaturation
OPERATIONAL DEFINITION
Emergence Period This will be defined as the time from the recovery of spontaneous breathing after giving reversal to tracheal extubation
Quality of emergence Good quality emergence will be defined as extubation not associated with coughing bucking tachycardia hypertension laryngospasm or bronchospasm
Tachycardia and hypertension Rise in heart rate and blood pressure more than 20 from baseline value
Extubation response Physiological response related to blood pressure and heart rate during extubation of trachea is called extubation response
HYPOTHESIS
Tramadol obtunds haemodynamic and cough response to extubation and thus results in good quality emergence after supratentorial craniotomy
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None