Intravenous MELAtonin for prevention of Postoperative Agitation and Emergence Delirium in children (MELA-PAED): A protocol and statistical analysis plan for a randomized clinical trial

Anne Louise de Barros Garioud*, Lars Peter Kloster Andersen, Aksel Karl Georg Jensen, Hien Quoc Do, Janus Christian Jakobsen, Lars Broksø Holst, Lars Simon Rasmussen, Arash Afshari

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

1 Citationer (Scopus)
15 Downloads (Pure)

Abstract

Background
Emergence agitation and delirium in children remain a common clinical challenge in the post-anesthetic care unit. Preoperative oral melatonin has been suggested as an effective preventive drug with a favorable safety profile. The oral bioavailability of melatonin, however, is low. Therefore, the MELA-PAED trial aims to investigate the efficacy and safety of intraoperative intravenous melatonin for the prevention of emergence agitation in pediatric surgical patients.

Methods
MELA-PAED is a randomized, double-blind, parallel two-arm, multi-center, superiority trial comparing intravenous melatonin with placebo. Four hundred participants aged 1–6 years will be randomized 1:1 to either the intervention or placebo. The intervention consists of intravenous melatonin 0.15 mg/kg administered approximately 30 min before the end of surgery. Participants will be monitored in the post-anesthetic care unit (PACU), and the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) will be performed on days 1, 7, and 14 after the intervention. Serious Adverse Events (SAE) will be assessed up to 30 days after the intervention.

Results
The primary outcome is the incidence of emergence agitation, assessed dichotomously as any Watcha score >2 during the participant's stay in the post-anesthetic care unit. Secondary outcomes are opioid consumption in the post-anesthetic care unit and adverse events. Exploratory outcomes include SAEs, postoperative pain, postoperative nausea and vomiting, and time to awakening, to first oral intake, and to discharge readiness.

Conclusion
The MELA-PAED trial investigates the efficacy of intravenous intraoperative melatonin for the prevention of emergence agitation in pediatric surgical patients. Results may provide further knowledge concerning the use of melatonin in pediatric perioperative care.
OriginalsprogEngelsk
TidsskriftActa Anaesthesiologica Scandinavica
Vol/bind68
Udgave nummer2
Sider (fra-til)280-286
Antal sider7
ISSN0001-5172
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
The trial has received unrestricted grants from Rigshospitalet Research Grants, Oberstinde Kirsten Jensa la Cours Legat, Lægeforeningens Forskningsfond, DASAIMs Forskningsinitiativ, Dagmar Marshalls Fond, Lippmann Fonden, and Kong Christian den Tiendes Fond.

Publisher Copyright:
© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

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