A Comparison of the Effects of Intraoperative Administration of Metoprolol or Esmolol on General Anesthetic Requirement
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Purpose
We will compare three study groups receiving metoprolol, esmolol, or placebo. Level of anesthesia will be titrated to achieve the same range of BIS value in all groups. Our hypothesis is that the metoprolol and esmolol groups will require a lower level of anesthetic agent to achieve the targeted BIS range, compared to the placebo group.
Our objective is to clarify if metoprolol, in a dose range used for perioperative cardiac protection, decreases anesthetic requirement.
| Condition | Intervention |
|---|---|
|
Myocardial Ischemia |
Drug: Metoprolol Drug: Esmolol Drug: Placebo |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) |
| Official Title: | A Comparison of the Effect of Intraoperative Administration of Metoprolol or Esmolol on General Anesthetic Requirement |
- Our objective is to clarify if metoprolol, in a dose range used for perioperative cardiac protection, decreases anesthetic requirement. [ Time Frame: During the procedure ] [ Designated as safety issue: Yes ]
- Administration of esmolol, a short-acting beta-receptor antagonist, might reduce the actual anesthetic requirement. [ Time Frame: During the procedure ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 60 |
| Study Start Date: | July 2010 |
| Estimated Study Completion Date: | December 2013 |
| Estimated Primary Completion Date: | November 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: 1
metoprolol at 1mg/ml concentration
|
Drug: Metoprolol
60ml syringes of 0.9% NaCl, 5ml syringes of metoprolol at 1mg/ml concentration
|
|
Experimental: 2
esmolol at 10 mg/ml concentration
|
Drug: Esmolol
60ml syringes of esmolol at 10 mg/ml concentration, 5ml syringes of 0.9% of NaCl
|
| Placebo Comparator: 3 |
Drug: Placebo
Placebo group: 60 ml syringes of 0.9% NaCl, 5 ml syringes of 0.9% NaCl |
Detailed Description:
Beta-receptor antagonists are commonly used in the perioperative setting. These agents have been shown to decrease the incidence of perioperative myocardial ischemia and are recommended by a recent practice guideline in certain patient groups.1 Besides protection from ischemia, there are other situations where beta-receptor antagonists are used intraoperatively such as control of the sympathetic response to tracheal intubation and certain types of surgical stimuli.
There is new evidence suggesting that administration of esmolol, a short-acting beta-receptor antagonist, might reduce the actual anesthetic requirement. This was initially shown by studies in which esmolol decreased the amount of anesthetic required to prevent movement after skin incision.2;3 Subsequent studies used bispectral index (BIS) as an endpoint and demonstrated decreased BIS values in subjects receiving esmolol during general anesthesia. 4;5
This anesthetic-sparing effect observed with esmolol has not been prospectively studied with other beta-receptor antagonists. Since perioperative beta-blockade is commonly achieved using longer acting agents such as metoprolol or atenolol, it is clinically relevant to understand the effects of these medications on anesthetic requirement. We aim to conduct a prospective, randomized, controlled, double-blind study to compare the anesthetic-sparing effect of metoprolol and esmolol administered intraoperatively.
Eligibility| Ages Eligible for Study: | 18 Years to 75 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Being older than 18 but, not older than 75
- Scheduled for surgery under general anesthesia
- Duration of surgery scheduled as 2 hours or longer
Exclusion Criteria:
- Intracranial or intrathoracic surgery (due to difficulty using a BIS monitor or frequent need for beta-receptor antagonism)
- Indication for perioperative beta-receptor antagonism
- Current use of calcium-channel antagonists
- History of coronary artery disease
- History of reactive airway disease
- History of diabetes or other disorders of glucose metabolism
- Reported allergy to any of the study drugs
- Reported substance abuse (except nicotine and caffeine)
- Use of monoamine oxidase (MAO) inhibitor drugs
- Hypersensitivity to metoprolol, esmolol and related derivatives, or to any of the excipients of either.
- Hypersensitivity to other beta-blockers (cross-sensitivity between beta-blockers can occur).
- Sick-sinus Syndrome.
- Heart block greater than first degree, cardiogenic shock, and overt cardiac failure.
- Significant first-degree heart block (P-R interval greater than or equal to 0.24 sec; systolic pressure < 100mmHg; or moderate- to-severe cardiac failure).
- Severe peripheral arterial circulatory disorders.
- Pheochromocytoma.
- Baseline heart rate of < 60
- Systolic pressure less than 100 mm Hg
- Pregnant women
- Prisoners
Contacts and Locations| Contact: Pramod Chetty, MD | 405-271-4351 | Pramod-Chetty@ouhsc.edu |
| Contact: Qaiser S Khan, MD,MPH | 405-271-8001 ext 36016 | qaiser-khan@ouhsc.edu |
| United States, Oklahoma | |
| Univeristy of Oklahoma Health Sciences Center Dept. Anesthesiology | Recruiting |
| Oklahoma, Oklahoma, United States, 73104 | |
| Contact: Pramod Chetty, M.D 405-271-4351 Pramod-Chetty@ouhsc.edu | |
| Contact: Qaiser Khan, MD,MPH 405-271-8001 ext 36016 qaiser-khan@ouhsc.edu | |
| Principal Investigator: Pramod Chetty, MD | |
More Information
Additional Information:
No publications provided
| Responsible Party: | University of Oklahoma |
| ClinicalTrials.gov Identifier: | NCT00756236 History of Changes |
| Other Study ID Numbers: | 14301 |
| Study First Received: | September 19, 2008 |
| Last Updated: | January 15, 2013 |
| Health Authority: | United States: Food and Drug Administration |
Additional relevant MeSH terms:
|
Myocardial Ischemia Coronary Artery Disease Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Coronary Disease Arteriosclerosis Arterial Occlusive Diseases Pathologic Processes Anesthetics, General Anesthetics Metoprolol Esmolol Metoprolol succinate |
Central Nervous System Depressants Physiological Effects of Drugs Pharmacologic Actions Central Nervous System Agents Therapeutic Uses Anti-Arrhythmia Agents Cardiovascular Agents Antihypertensive Agents Sympatholytics Autonomic Agents Peripheral Nervous System Agents Adrenergic beta-1 Receptor Antagonists Adrenergic beta-Antagonists Adrenergic Antagonists Adrenergic Agents |
ClinicalTrials.gov processed this record on May 16, 2013