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Trial registered on ANZCTR
Registration number
ACTRN12613000697785
Ethics application status
Approved
Date submitted
20/06/2013
Date registered
26/06/2013
Date last updated
26/06/2013
Type of registration
Prospectively registered
Titles & IDs
Public title
Measuring the benefit of buccal oxygenation in the apnoeic patient
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Scientific title
Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of buccal RAE tube oxygen administration
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Secondary ID [1]
282716
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Obesity
289434
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Desaturation during laryngoscopy (anaesthesia)
289435
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Condition category
Condition code
Anaesthesiology
289763
289763
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0
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Anaesthetics
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Respiratory
289793
289793
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0
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Other respiratory disorders / diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
In theatre patients will receive a standardised induction of anesthesia . For the the laryngoscopy (procedure to visualise the vocal cords and therefore entrance into the windpipe) and intubation (placement of the endotracheal tube into the windpipe) in the anaesthetised and apnoeic patient, the oxygen administration is traditionally interrupted for a short time until the breathing tube is connected to the ventilator. In this study the patients are either receiving additional oxygen (10 l/min flow) via a 3.5 mm RAE tube in the buccal space during laryngascopy or no additional oxygen. During artificially prolonged laryngoscopy the saturation will be recorded for a maximum of 10 min or until the saturation starts to drop to 95%. The patient will then be intubated and anaesthesia will be continued as per routine.
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Intervention code [1]
287377
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Prevention
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Intervention code [2]
287402
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Treatment: Other
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Comparator / control treatment
Oxygen 10 l/min versus no flow
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Control group
Active
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Outcomes
Primary outcome [1]
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Desaturation (SpO2 to 95%) monitored with pulse oximetry
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Assessment method [1]
289848
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Timepoint [1]
289848
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Time to reach SpO2 95% in seconds or 10 min if no desaturation occurs
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Secondary outcome [1]
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NIL
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Assessment method [1]
303376
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Timepoint [1]
303376
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NIL
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Eligibility
Key inclusion criteria
1) Adult patients requiring general anaesthesia with endotrachel intubation for scheduled surgery
2) BMI 30-40
3) ASA1-2
4) Agree to and capapble of understanding and signing the consent form
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Study population - Exclusion criteria:
1) Age < 18
2) Chronic Respiratory Disease
3 ) SpO2 <98% despite preoxygenation with 100% O2
4) History of difficult intubation or anticipated difficult intubation
5) Uncontrolled hypertension
6) Ischaemic Heart disease or congestive Heart Failure
7) Increased intracranial pressure
7) Gastroesophageal reflux disease
8) Non fasting patients
9) Emergency procedures
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
sealed opaque envelopes
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
computerised sequence generation
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
A power analysis was performed to determine the number of subjects required for the study.
We expected a minimum of 60 seconds difference between the SpO2>95% times of the two groups. Based on this assumption and Type I and Type II errors of 5% and 20%, respectively(power 80%), 15 patients per group were required to prove the hypothesis.
To account for withdrawasls and fall-outs n=20 will be recruited for each group.
All continuous data were identified as nonparameteric and the Mann Whitney U test was used to determine statistical significance between groups. Pearson's chi-squared test and Fisher's exact test will be used to show significant differences between the two groups in frequency data. Statistical analysis(SPSS15.0 for Windows Software) will be used to perform the statistical analysis.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
27/06/2013
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Actual
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Date of last participant enrolment
Anticipated
20/06/2014
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
40
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
1147
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Royal Perth Hospital - Perth
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Recruitment postcode(s) [1]
6994
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6847 - Perth
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Funding & Sponsors
Funding source category [1]
287487
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Self funded/Unfunded
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Name [1]
287487
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Address [1]
287487
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Country [1]
287487
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Primary sponsor type
Hospital
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Name
Department of Anaesthesia, Royal Perth Hospital
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Address
Wellington Street Campus
BOX X2213, GPO
Perth 6847
Western Australia
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Country
Australia
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Secondary sponsor category [1]
286227
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None
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Name [1]
286227
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Address [1]
286227
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Country [1]
286227
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
289463
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Human Research Ethics Committee
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Ethics committee address [1]
289463
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Level 5 Colonial House, Royal Perth Hospital, GPO Box X2213 Perth WA 6001
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Ethics committee country [1]
289463
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Australia
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Date submitted for ethics approval [1]
289463
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Approval date [1]
289463
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13/06/2013
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Ethics approval number [1]
289463
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REG 13-050
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Summary
Brief summary
Patients having operations under general anaesthesia will be asleep for the duration of the procedure and their own breathing efforts will be reduced by the anaesthetic drugs. The anaesthetist will support the patients breathing and will place a breathing tube into his/her windpipe as soon as the patient have drifted off to sleep. Normally, the anaesthetist discontinues the administration of oxygen during this manoeuvre as it usually takes only a short time to insert the breathing tube. We believe that continuing the supply of oxygen through a small tube into the inside of the patients cheek at this stage will keep the body oxygen levels higher than they would be otherwise. This is especially important for patients who are overweight or pregnant and also in children as their oxygen reserves exhaust more quickly. Computer programs and our understanding of the biology of people have suggested this would be the case. However, we do not have proof of this at present.
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Trial website
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Trial related presentations / publications
1. Altermatt FR, Munoz HR, Delfino AE, Cortinez LI. Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea. Br J Anaesth 2005;95:706-9. 2. Gander S, Frascarolo P, Suter M, Spahn DR, Magnusson L. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg 2005;100:580-4. 3. Dixon BJ, Dixon JB, Carden JR, Burn AJ, Schachter LM, Playfair JM, Laurie CP, O'Brien PE. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology 2005;102:1110-5; discussion 5A. 4. Jense HG, Dubin SA, Silverstein PI, O'Leary-Escolas U. Effect of obesity on safe duration of apnea in anesthetized humans. Anesth Analg 1991;72:89-93. 5. Teller LE, Alexander CM, Frumin MJ, Gross JB. Pharyngeal insufflation of oxygen prevents arterial desaturation during apnea. Anesthesiology 1988;69:980-2. 6. Baraka AS, Taha SK, Siddik-Sayyid SM, Kanazi GE, El-Khatib MF, Dagher CM, Chehade JM, Abdallah FW, Hajj RE. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia 2007;62:769-73. 7. Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth;22:164-8.
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Public notes
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Contacts
Principal investigator
Name
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Dr Andrew Heard
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Address
40958
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Department of Anaesthesia and Pain Medicine
Royal Perth Hospital
Wellington Street Campus
BOX X2213, GPO, Perth 6487
Western Australia
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Country
40958
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Australia
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Phone
40958
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+61 8 92241037
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Fax
40958
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+61 8 92241111
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Email
40958
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[email protected]
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Contact person for public queries
Name
40959
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Andrew Heard
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Address
40959
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Department of Anaesthesia and Pain Medicine
Royal Perth Hospital
Wellington Street Campus
BOX X2213, GPO, Perth 6487
Western Australia
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Country
40959
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Australia
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Phone
40959
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+61 8 92241037
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Fax
40959
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+61 8 92241111
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Email
40959
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[email protected]
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Contact person for scientific queries
Name
40960
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Andrew Heard
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Address
40960
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Department of Anaesthesia and Pain Medicine
Royal Perth Hospital
Wellington Street Campus
BOX X2213, GPO, Perth 6487
Western Australia
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Country
40960
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Australia
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Phone
40960
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+61 8 92241037
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Fax
40960
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+61 8 92241111
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Email
40960
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Apneic oxygenation during prolonged laryngoscopy in obese patients: A randomized, controlled trial of buccal RAE tube oxygen administration.
2017
https://dx.doi.org/10.1213/ANE.0000000000001564
N.B. These documents automatically identified may not have been verified by the study sponsor.
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