E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Adult over 18 years, of both sexes, for which a procedural sedation is needed in emergency room. |
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E.1.1.1 | Medical condition in easily understood language |
Adult over 18 years, of both sexes, for which a procedural sedation is needed in emergency room. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Symptoms and general pathology [C23] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The main objective is to determine if combinaison of dexmédétomidine and alfentanil allows a level of conscious sedation within maximum security conditions in an emergency department. |
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E.2.2 | Secondary objectives of the trial |
1. Check the relation between the patient's level of anxiety and the drugs (dexmédétomidine and l’alfentanil) quality of response
2.Determine the requested total dose of dexmédétomidine to obtain a level of sedation corresponding to the Ramsey score 2-3
3. Determine the requested time in minutes to reach the Ramsey score 2-3
4.Determine the requested total dose of alfentanil to reach a good level of analgesia
5.Observe the evolution of the pain score durring the procedure. It will be evaluated before and after the procedure with the numerical scale.
6.Observe the evolution of the patient's anxiety before and after the treatment
7. Compared the results with the « Assessment of Alertness/Sedation (OAA/S) scale » and those obtained by the Ramsay score assessment as well as to the modification of the bispectral index during the sedation |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Adult over 18 years, of both sexes, for which a procedural sedation is needed in emergency room. The rules for sedation, in accordance with the international guidelines, are:
• Insertion of a chest drain
• Abscess incision and drainage
• Electrical cardio version
• Closed reduction of a dislocated joint
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E.4 | Principal exclusion criteria |
-Patients refusing to participate in the study (refusal to sign the consent form)
-Patients refusing sedation
-Patients unable to participate in the study (consent is impossible to obtain)
-Pregnant women
-Patients with poor respiratory status determined by :
Respiratory rate > 30 / min
Oxygen saturation <90%
- Patients with unfavorable hemodynamic status determined by :
A heart rate > 120 / min
A heart rate < 45 / min
Systolic blood pressure ≥ 180 mmHg or ≤100mmHg
Diastolic blood pressure ≥ 110mmHg
- Patients with contraindication to the use of dexmedetomidine :
Advanced heart block (level 2 or 3) unless pacemaker
Acute cerebrovascular disease
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Can we obtain an adequate level of sedation with dexmedetomidine and alfentanyl in an emergency department?
The Ramsay score scale will evaluate the sedation level
The objective is to reach a score of 2 or 3 on the Ramsay score scale
2. Can we do a procedural sedation with dexmedetomidine in optimal safety conditions in an emergency department?
The optimal safety conditions are determined by:
1. A stable blood pressure
2. A stable heart rhythm
3. No respiratory depression
4. Absence of hypoxia
5. Absence of vomiting
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The monitoring of the cardiovascular functions, the respiratory status and the sedation level will be performed as follows:
Continually: for heart rate, oxygen saturation and EtCO2
Every 3 min : for blood pressure and respiratory frequency
Every 5 min : for Ramsay sedation score , the OAAS and BIS
The observation of the change of the « Pleth Variability Index »
The level of anxiety and pain will be evaluated before and after the procedure.
The level of pain will be evaluated by a numerical scale (EN).
The level of anxiety of the patient will be assessed by quantification of anxiety on a VAS scale.
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E.5.2 | Secondary end point(s) |
1. Wich dose of dexmedetomidine is needed to obtain the adequate sedation?
2. How long do we need to obtain adequate sedation?
3. Which dose of alfentanil do we need to obtain the adequate analgesia?
4. Evolution of patient’s pain will be assessed during the procedure. It will be evaluated before and after the procedure using the numerical scale
5. Evolution of patient’s pain will be assessed before and after the treatment of the combination dexmedetomidine – alfentanil
6. A comparison will be made between changes in the bispectral index (BIS) during sedation with the results obtained by the scale of sedation " Assessment of Alertness / Sedation (OAA / S) scale " and those obtained by the Ramsay score scale
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
The monitoring of the cardiovascular functions, the respiratory status and the sedation level will be performed as follows:
Continually: for heart rate, oxygen saturation and EtCO2
Every 3 min : for blood pressure and respiratory frequency
Every 5 min : for Ramsay sedation score , the OAAS and BIS
The observation of the change of the « Pleth Variability Index »
The level of anxiety and pain will be evaluated before and after the procedure.
The level of pain will be evaluated by a numerical scale (EN).
The level of anxiety of the patient will be assessed by quantification of anxiety on a VAS scale.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |