Animal studies suggest general anaesthetics harm the developing brain. It is unclear if these findings are relevant to humans but the issue has become a major concern. Recent data have found that monkeys exposed to anaesthesia as infants grow up to have slower learning than those not exposed. The aim of the TREX pilot study is to determine the feasibility of an alternative anaesthetic regimen for lower abdominal/lower extremity surgery in infants 1-12 months of age.
Animal studies suggest general anaesthetics harm the developing brain. It is unclear if these findings are relevant to humans but the issue has become a major concern. Recent data have found that monkeys exposed to anaesthesia as infants grow up to have slower learning than those not exposed. The aim of the TREX pilot study is to determine the feasibility of an alternative anaesthetic regimen for lower abdominal/lower extremity surgery in infants 1-12 months of age. An alternative anaesthetic regimen comprises a dexmedetomidine-based anaesthetic, augmented with an opioid (remifentanil) and a regional nerve block (such as a caudal). This open label prospective single arm pilot study will enrol 60 infants aged 1-12 months scheduled for lower limb, urologic, or lower abdominal surgery. After sevoflurane induction, the infants will have a caudal anaesthetic and intravenous dexmedetomidine and remifentanil. The outcome will be need for intervention for light anaesthesia, intervention for haemodynamic changes and rate of abandoning the protocol. Recovery times will also be recorded.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Loading dose:1 mcg/kg over 10 minutes. Infusion: Start 1-1.5 mcg/kg/hr. Titrate up or down within 50% of starting doses as needed.
Loading dose: 1 mcg/kg over 1-2 minutes. Infusion: Start at 0.2-0.5 mcg/kg/min. Titrate up or down (max 0.5 mcg/kg/min) as needed.
Administered in caudal/epidural/field block: 0.175%-0.25% (dose at discretion of anaesthetist)
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
Oregon Health and Science University
Portland, Oregon, United States
The University of Texas Southwestern Medical Center
Dallas, Texas, United States
Texas Children's Hospital
Houston, Texas, United States
Number of participants who need for intervention for light anaesthesia
Rescue treatment for light anaesthesia will be given if hypertension MAP \> 80 mmHg (confirmed with repeated measure) and/or patient movement.
Time frame: 120 minutes (duration of surgery)
Number of participants who need for intervention for haemodynamic changes
1. Rescue treatment for mild Hypotension will be given if MAP is between 40 mmHg and \<50 mmHg (confirmed with repeated measure) 2. Moderate Hypotension will be defined as MAP \<40 mmHg 3. Mild bradycardia will be defined as HR \<100 bpm for over one minute 4. Significant bradycardia will be defined as \<70 bpm over one minute
Time frame: 120 minutes (duration of surgery)
Time to recovery after anaesthesia
Time frame: Time from last dressing to: eye opening, removal of airway device, first feed, and a modified Aldrete Score of 9-10 (average 30 minutes-4 hours)
Number of participants who have respiratory complications
Any episode of coughing, oxygen desaturation \<90%, breath holding \> 15 seconds
Time frame: Start of anaesthesia until discharge from PACU (average 1-4 hours)
Number of participants who have pain after anaesthesia
FLACC (Face, Legs, Activity, Cry, Consolability) scale. The scale is scored in a range of 0-10 with 0 representing no pain.
Time frame: End of surgery until discharge from PACU ( average 1-4 hours)
Number of participants who require rescue analgesia in PACU
Analgesia: morphine 0.025-0.05 mg/kg IV for analgesia; repeat 20 minutes. Analgesia thereafter as per local protocol
Time frame: End of surgery until discharge from PACU (average 1-4 hours)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Administered in caudal/epidural/field block: 0.2% (dose at discretion of anaesthetist)
Royal Children's Hospital
Parkville, Victoria, Australia
KK Women's and Children's Hospital
Singapore, Singapore