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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT02353182
Registration number
NCT02353182
Ethics application status
Date submitted
26/01/2015
Date registered
2/02/2015
Titles & IDs
Public title
The T REX Pilot Study: a Study to Investigate the Use of an Alternative Anaesthetic in Infants.
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Scientific title
An Open Label Pilot Study of Feasibility of a Dexmedetomidine-Remifentanil-Caudal Anaesthetic for Infant Lower Abdominal/Lower Extremity Surgery: The TREX Pilot Study
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Secondary ID [1]
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35014
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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:
Surgical Procedures, Operative
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0
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Condition category
Condition code
Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Dexmedetomidine
Treatment: Drugs - Remifentanil
Treatment: Drugs - Bupivacaine
Treatment: Drugs - Ropivacaine
Experimental: Active open label single arm - Dexmedetomidine- remifentanil- caudal based anaesthetic for lower abdominal/lower extremity surgery.
Dexmedetomidine (Precedex): loading dose: 1 mcg/kg over 10 minutes. Infusion: Start 1 mcg/kg/hr; titrate up or down within 50% of starting doses as needed
Remifentanil (Ultiva): loading dose: 1 mcg/kg over 1-2 minutes. Infusion: Start at 0.2 mcg/kg/min. Titrate up or down (max 0.5 mcg/kg/min) as needed
Caudal- Bupivacaine (Marcaine) 0.175%-0.25% or Ropivacaine (Naropin) 0.2% with dose at discretion of anaesthetist
Treatment: Drugs: Dexmedetomidine
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.
Treatment: Drugs: Remifentanil
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.
Treatment: Drugs: Bupivacaine
Administered in caudal/epidural/field block: 0.175%-0.25% (dose at discretion of anaesthetist)
Treatment: Drugs: Ropivacaine
Administered in caudal/epidural/field block: 0.2% (dose at discretion of anaesthetist)
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Number of participants who need for intervention for light anaesthesia
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Assessment method [1]
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Rescue treatment for light anaesthesia will be given if hypertension MAP \> 80 mmHg (confirmed with repeated measure) and/or patient movement.
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Timepoint [1]
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120 minutes (duration of surgery)
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Secondary outcome [1]
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Number of participants who need for intervention for haemodynamic changes
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Assessment method [1]
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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
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Timepoint [1]
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120 minutes (duration of surgery)
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Secondary outcome [2]
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Time to recovery after anaesthesia
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Assessment method [2]
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Timepoint [2]
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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)
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Secondary outcome [3]
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Number of participants who have respiratory complications
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Assessment method [3]
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Any episode of coughing, oxygen desaturation \<90%, breath holding \> 15 seconds
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Timepoint [3]
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Start of anaesthesia until discharge from PACU (average 1-4 hours)
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Secondary outcome [4]
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Number of participants who have pain after anaesthesia
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Assessment method [4]
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FLACC (Face, Legs, Activity, Cry, Consolability) scale. The scale is scored in a range of 0-10 with 0 representing no pain.
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Timepoint [4]
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End of surgery until discharge from PACU ( average 1-4 hours)
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Secondary outcome [5]
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Number of participants who require rescue analgesia in PACU
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Assessment method [5]
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Analgesia: morphine 0.025-0.05 mg/kg IV for analgesia; repeat 20 minutes. Analgesia thereafter as per local protocol
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Timepoint [5]
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End of surgery until discharge from PACU (average 1-4 hours)
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Eligibility
Key inclusion criteria
* Infants aged 1 to 12 months (corrected age)
* ASA I or II
* Infants undergoing lower abdominal/lower extremity surgery anticipated to be > 120 minutes in duration
* Surgery requires caudal regional nerve block
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Minimum age
1
Month
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Maximum age
12
Months
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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
* ASA III or higher
* Any contraindication to caudal analgesia
* Any contraindication to an inhalational induction with sevoflurane
* Allergies to any medication in study protocol
* Planned admission to an ICU postoperatively (except level II or III neonatal ICU)
* Planned tracheal intubation postoperatively
* Mechanical ventilation postoperatively
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Study design
Purpose of the study
Treatment
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Allocation to intervention
NA
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Phase 4
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/05/2015
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
1/09/2016
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Sample size
Target
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Accrual to date
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Final
60
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Royal Children's Hospital - Parkville
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Recruitment postcode(s) [1]
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3052 - Parkville
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Recruitment outside Australia
Country [1]
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United States of America
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State/province [1]
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Ohio
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Country [2]
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United States of America
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State/province [2]
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Oregon
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Country [3]
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United States of America
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State/province [3]
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Texas
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Country [4]
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Singapore
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State/province [4]
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Singapore
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Funding & Sponsors
Primary sponsor type
Other
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Name
Murdoch Childrens Research Institute
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Baylor College of Medicine
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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Boston Children's Hospital
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Address [2]
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Country [2]
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Other collaborator category [3]
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Other
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Name [3]
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Oregon Health and Science University
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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The Royal Children's Hospital Melbourne
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Address [4]
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Country [4]
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Other collaborator category [5]
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Other
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Name [5]
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UMC Utrecht
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Address [5]
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Country [5]
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Other collaborator category [6]
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Other
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Name [6]
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Children's Hospital Medical Center, Cincinnati
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Address [6]
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Country [6]
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Other collaborator category [7]
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Other
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Name [7]
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Children's Hospital of Philadelphia
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Address [7]
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Country [7]
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Other collaborator category [8]
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Other
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Name [8]
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Sydney Children's Hospitals Network
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Address [8]
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Country [8]
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Other collaborator category [9]
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Other
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Name [9]
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The Cleveland Clinic
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Address [9]
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Country [9]
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Other collaborator category [10]
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Other
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Name [10]
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Princess Margaret Hospital for Children
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Address [10]
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Country [10]
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Other collaborator category [11]
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Other
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Name [11]
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University Hospital, Geneva
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Address [11]
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Country [11]
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Other collaborator category [12]
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Other
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Name [12]
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Starship Children's Health
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Address [12]
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Country [12]
0
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Other collaborator category [13]
0
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Other
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Name [13]
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University of Texas Southwestern Medical Center
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Address [13]
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Country [13]
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Other collaborator category [14]
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Other
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Name [14]
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Gaslini Children's Hospital
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Address [14]
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Country [14]
0
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Other collaborator category [15]
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Government body
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Name [15]
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KK Women's and Children's Hospital
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Address [15]
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Country [15]
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Ethics approval
Ethics application status
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Summary
Brief summary
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.
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Trial website
https://clinicaltrials.gov/study/NCT02353182
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Andrew J Davidson, MD
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Address
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Murdoch Childrens Research Institute
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Data will be presented as group data and no individual will be identified.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT02353182