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| Name | Class |
|---|---|
| Foundation for Anesthesia Education and Research | OTHER |
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The purpose of this study is to determine the effects of pain on facilitating long-term auditory memory in the presence and absence of distinct intravenous anesthetics. The ability to identify previously presented words from a list assessed the degree of memory formation. In a subset of subjects, functional magnetic resonance imaging was used to identify the neural correlates of memory inhibition or facilitation by the combination of pain and anesthetic used.
This study adds specific details to the current incomplete body of knowledge examining the effect of pain on memory formation under the influence of anesthetic agents.
Pain and anesthetic agents were administered as experimental variables in this study. Healthy adult subjects were played repeated lists of words and performed several decision-making tasks that encourage memory encoding. Some words were consistently paired with painful electric shock, and was anticipated to improve subsequent memory performance specifically for those items. The same experiment was repeated in all subjects during the administration of 1-2 possible agents that reduce memory formation: dexmedetomidine, a predominantly sedative agent, and midazolam, a well-known amnestic agent, and ketamine, a well-known dissociative analgo-sedative. The extent to which pain modulates memory performance under the effects of the anesthetic agents was the primary outcome of interest.
Further, a subset of the subjects performed the same experimental procedures while undergoing functional magnetic resonance imaging, which continuously reflects neuronal activity throughout the brain. Classic memory areas were predicted to be activated by the auditory processing task, but how these neural circuits change under the two anesthetic agents with the concomitant experience of pain were of interest. It was anticipated that pain recruits a parallel memory pathway using limbic structures, known for their involvement in fear conditioning. Additionally, stronger and more diffuse cortical processing likely occurs with concomitant pain, as level of sedation was reduced by this strong stimulus. Discovering the anatomic correlates specific to each experimental variable (pain and anesthetic), and their interplay, may help refine our model of brain function during the dynamics of pain and sedation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dexmedetomidine Only | Experimental | All subjects receive saline (control), followed by a dexmedetomidine infusion. They also experience intermittent experimental pain delivered by peripheral nerve stimulation. |
|
| Midazolam Only | Experimental | Subjects receive saline (control), followed by midazolam infusion. They also experience intermittent experimental pain delivered by peripheral nerve stimulation. |
|
| Ketamine Only | Experimental | All subjects receive saline (control), followed by ketamine infusion. They also experience intermittent experimental pain delivered by peripheral nerve stimulation. |
|
| Saline/Midazolam/Saline/Ketamine | Experimental | All subjects receive saline (control), followed by midazolam infusion. They also experience intermittent experimental pain delivered by peripheral nerve stimulation. Subjects then returned at least 1 week later for another set of experimental sessions with the same design, however the saline was followed by ketamine infusion. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dexmedetomidine | Drug | Selected subjects received this drug during a portion of the study |
|
| Measure | Description | Time Frame |
|---|---|---|
| Memory Testing | Subjects completed the Remember, Know, New (RKN) task during next day testing. Their d' memory score was calculated based on their ability to discriminate between previously heard words and new words. A higher d' score indicates stronger recollection. D' scores were compared across the control condition (saline) and the drug conditions dexmedetomidine, midazolam, and ketamine. Performance was also calculated according to words associated with Pain and No Pain conditions. | At memory testing 1 day later |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Keith M Vogt, MD, PhD | University of Pittsburgh | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Pittsburgh | Pittsburgh | Pennsylvania | 15213 | United States |
Data will be published. After all analysis and dissemination is complete, functional images will be shared via data repository.
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| ID | Title | Description |
|---|---|---|
| FG000 | Dexmedetomidine | subjects received dexmedetomidine and saline (control) |
| FG001 | Midazolam | subjects received midazolam and saline (control) |
| FG002 | Ketamine | subjects received ketamine and saline (control) |
| FG003 | Drug Order A | Subjects received saline (control) and midazolam during their first set of experimental sessions, and then received saline (control) and ketamine during a second set of sessions |
| FG004 | Drug Order B | Subjects received saline (control) and ketamine during their first set of experimental sessions, and then received saline (control) and midazolam during a second set of sessions |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Dexmedetomidine Only | All subjects received saline (control) followed by dexmedetomidine infusion while performing memory task and receiving intermittent painful electric nerve stimulation. |
| BG001 | Midazolam Only |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Memory Testing | Subjects completed the Remember, Know, New (RKN) task during next day testing. Their d' memory score was calculated based on their ability to discriminate between previously heard words and new words. A higher d' score indicates stronger recollection. D' scores were compared across the control condition (saline) and the drug conditions dexmedetomidine, midazolam, and ketamine. Performance was also calculated according to words associated with Pain and No Pain conditions. | The overall number analyzed for each drug condition represents the number of observations for that drug, which doesn't directly correspond to study arms. All participants received a saline control condition with their drug condition. Therefore, there were 48 saline observations (saline d' scores) which includes observations from all 5 study arms. | Posted | Mean | Standard Error | d' score | At memory testing 1 day later | number of observations for each drug | number of observations for each drug |
|
up to 18 days after the final experimental session
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Dexmedetomidine Only | Dexmedetomidine: Subjects received this drug during a portion of the study |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea and vomiting | Gastrointestinal disorders | Systematic Assessment | Participants who experienced adverse events (both those in the Ketamine Only group and in Drug Order A) reported the adverse event during ketamine administration. |
Functional imaging results are being prepared for publication.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Keith M. Vogt, MD., PhD. | University of Pittsburgh | 412-999-8570 | vogtkm@upmc.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| SAP | No | Yes | No | Statistical Analysis Plan | Apr 24, 2020 | Apr 27, 2020 | SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Feb 23, 2018 | Apr 27, 2020 | ICF_001.pdf |
| Prot | Yes | No | No | Study Protocol | Jan 30, 2019 | May 20, 2020 | Prot_002.pdf |
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| ID | Term |
|---|---|
| D000647 | Amnesia |
| D010146 | Pain |
| ID | Term |
|---|---|
| D008569 | Memory Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D020927 | Dexmedetomidine |
| D008874 | Midazolam |
| D004561 | Transcutaneous Electric Nerve Stimulation |
| D007649 | Ketamine |
| ID | Term |
|---|---|
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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There are 3 single drug arms completed by a few participants. The majority of participants participated in a crossover design with two drugs, midazolam & ketamine.
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| Saline/Ketamine/Saline/Midazolam |
| Experimental |
All subjects receive saline (control), followed by ketamine infusion. They also experience intermittent experimental pain delivered by peripheral nerve stimulation. Subjects then returned at least 1 week later for another set of experimental sessions with the same design, however the saline was followed by midazolam infusion. |
|
| Midazolam | Drug | Selected subjects received this drug during a portion of the study |
|
|
| Peripheral nerve stimulation | Device | Experimental acute pain stimulus was delivered using a nerve stimulator. These painful shocks were paired randomly with some of the auditory experimental cues. |
|
|
| Ketamine | Drug | Selected subjects received this drug during a portion of the study |
|
|
All subjects received saline (control) followed by midazolam infusion while performing memory task and receiving intermittent painful electric nerve stimulation.
| BG002 | Ketamine Only | All subjects received saline (control) followed by ketamine infusion while performing memory task and receiving intermittent painful electric nerve stimulation. |
| BG003 | Drug Order A | All subjects received saline (control) followed by midazolam infusion while performing memory task and receiving intermittent painful electric nerve stimulation on their first experimental visit. For another experimental session, all subjects received saline (control) followed by ketamine infusion while performing memory task and receiving intermittent painful electric nerve stimulation. |
| BG004 | Drug Order B | All subjects received saline (control) followed by ketamine infusion while performing memory task and receiving intermittent painful electric nerve stimulation on their first experimental visit. For another experimental session, all subjects received saline (control) followed by midazolam infusion while performing memory task and receiving intermittent painful electric nerve stimulation. |
| BG005 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
Subjects assigned to receive dexmedetomidine as part of the study |
| OG001 | Midazolam | Subjects assigned to receive midazolam as part of the study. Includes subjects from groups Midazolam Only, Drug Order A, and Drug Order B |
| OG002 | Ketamine | Subjects assigned to receive ketamine as part of the study. Includes subjects from groups Ketamine Only, Drug Order A, and Drug Order B |
| OG003 | Saline | All subjects subjects received saline as a control condition during their study visits. Includes subjects from Dexmedetomidine Only, Midazolam Only, Ketamine Only, Drug Order A, and Drug Order B. |
|
|
| 0 |
| 7 |
| 0 |
| 7 |
| 0 |
| 7 |
| EG001 | Midazolam Only | Midazolam: Subjects received this drug during a portion of the study | 0 | 4 | 0 | 4 | 0 | 4 |
| EG002 | Ketamine Only | Ketamine: Subjects received this drug during a portion of the study All adverse events for Ketamine Only subjects were experienced during ketamine administration. | 0 | 5 | 0 | 5 | 1 | 5 |
| EG003 | Drug Order A | Midazolam: Subjects received this drug during a portion of the study Ketamine: Subjects received this drug during a portion of the study These drugs were given on separate visits, occurring at least 14 days apart. All adverse events for Drug Order A subjects were experienced during ketamine administration. | 0 | 8 | 0 | 8 | 1 | 8 |
| EG004 | Drug Order B | Ketamine: Subjects received this drug during a portion of the study Midazolam: Subjects received this drug during a portion of the study These drugs were given on separate visits, occurring at least 14 days apart. All adverse events for Drug Order B subjects were experienced during ketamine administration. | 0 | 8 | 0 | 8 | 1 | 8 |
|
| Dysphoria | Psychiatric disorders | Systematic Assessment | The participant from Drug Order B experienced the adverse event during the ketamine administration |
|
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| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| D001569 |
| Benzodiazepines |
| D001552 | Benzazepines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D004599 | Electric Stimulation Therapy |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
| D000698 | Analgesia |
| D000760 | Anesthesia and Analgesia |
| D003510 | Cyclohexanes |
| D003516 | Cycloparaffins |
| D006840 | Hydrocarbons, Alicyclic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| Between 18 and 65 years |
|
| >=65 years |
|
| Male |
|