Compare induction of anaesthesia using etomidate versus ketanest on hemodynamics, as well as microcirculatory consequences in patients admitted to the ICU and in need of ventilatory support.
ID
Source
Brief title
Condition
- Other condition
- Lower respiratory tract disorders (excl obstruction and infection)
Synonym
Health condition
intensive care patiënten waarbij inductie van anesthesie geïndiceerd is
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
CVP (10 min average)
HR/BP (10 min average)
MAP (10 min average)
Urine output (60 min average)
Resuscitation volume (specific sum)
Inotropic support (value of rate and cumulative dose)
Vasopressor support (value of rate and cumulative dose)
Microcirculatory function
Secondary outcome
Ventilatory and oxygen delivery variables
Adverse psychological reactions
Background summary
Until recently, most anaesthetists and intensivists used etomidate as induction
agent for anaesthesia in cardiorespiratory compromised patients admitted to the
intensive care unit (ICU), because of its favourable effect on cardiovascular
stability. However, awareness of the adverse effects of a single induction dose
of etomidate on the adrenal gland has increased over the last decade.
Alternatively, ketanest can be used as an induction agent, probably with
comparable effects concerning macrocirculatory stability, but without
suppressing the adrenal gland. Therefore, induction of anaesthesia using
ketanest in critically ill patients may be superior compared to etomidate.
However, the effect of ketanest on the microcirculation is -until now- unknown.
Study objective
Compare induction of anaesthesia using etomidate versus ketanest on
hemodynamics, as well as microcirculatory consequences in patients admitted to
the ICU and in need of ventilatory support.
Study design
Prospective single-centre observational study.
Intervention:
Patients accepted for this study are alternately allocated to either the
ketanest (K) or etomidate (E) group. Anaesthesia is induced with either
ketanest (1 mg/kg) (K group) or etomidate (0.3 mg/kg) (E group). Sedation is
maintained with midazolam (10 mg/h) and morphine (2 mg/h) in both groups.
For the measurements of the microcirculatory consequences, short vascular
occlusions will be applied immediately prior to induction and at
5-10-15-20-30-45-60-90-120-150-180-210 and 240 minutes after induction.
Study burden and risks
Etomidate is a commonly used induction agent with cardiovascular stability and
adrenal gland suppression.
Ketanest is an anaesthetic induction agent with analgesic effects and usually
without depression of the cardiovascular and respiratory system.
NIRS is a noninvasive patient-friendly optical technique that uses
near-infrared light of low intensity and is completely harmless. This device
has frequently been used in an ICU setting as well as in healthy volunteers.
Vascular occlusion. NIRS will be used in combination with a manually applied
vascular occlusion. Application of vascular occlusion is short (1 min) and the
pressure used is comparable with the pressure used for a standard blood
pressure measurement or the occlusion applied for a routine venapunction.
Although the occlusion might be experienced as unpleasant or might cause
temporary pain, both are reversible and no damage will be done to the tissue.
Similar methods, with even longer occlusion time, have been used previously in
many studies including several in patients admitted to the ICU (for review see
Gerovasili, 2010).
weg dor jonkerbos 100
6532 sz Nijmegen
NL
weg dor jonkerbos 100
6532 sz Nijmegen
NL
Listed location countries
Age
Inclusion criteria
Patients in an intensive care unit:
1. in need for ventilatory support.
2. to be intubated on the ICU.
Exclusion criteria
1. <18 years old.
2. symptomatic coronary artery disease.
3. due to have surgery within 3 hours.
4. already on corticosteroid therapy
5. pregnancy.
6. pulmonary hypertension.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL37999.091.11 |