Clinical trial NCT07000877: Nasal Decongestant to Reduce Perioperative Adverse Events in Children With Upper Respiratory Track Infections Having Anesthesia.
Official title: Nasal Decongestant Administration to Reduce Perioperative Adverse Events in Children With Upper Respiratory Track Infections Having General Anesthesia - a Low Risk Intervention. (NARWHAL)
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE4
Conditions: Perioperative Respiratory Adverse Events
Anesthesia Outcomes
Keywords: perioperative respiratory adverse events
nasal decongestant
upper respiratory tract infection
Children
surgery
pediatrics
anesthesia
Lead sponsor: Telethon Kids Institute
Sponsor class: OTHER
Collaborators: name: Child and Adolescent Health Service - Perth
name: Hospital das Clínicas de São Paulo - SP
name: Rigshospitalet, Denmark
First posted: 2025-06-03
Enrollment: 200
Sex: ALL
Minimum age (years): 1
Maximum age (years): 8
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Multicentre, double-blinded randomised controlled trial
Primary purpose: PREVENTION

Brief summary: The goal of this multicentre, double-blind, randomised controlled trial study is to learn if the use of a nasal spray to open the nasal passages and increase airflow before surgery can reduce the occurrence of perioperative respiratory adverse events in children with upper respiratory tract infection who are undergoing anesthesia.

The main questions it aims to answer are:

* Does use of a nasal decongestant (Oxymetazoline 0.05%) reduce perioperative respiratory adverse events during emergence (when waking up from anesthesia) or in the post-anesthesia care unit in children.
* Is it easy and acceptable to doctors, children and parents to use the nasal decongestant treatment? Researchers will compare the nasal decongestant to a placebo (a look-alike substance that contains no drug) to see if it works to reduce perioperative respiratory adverse effects.

Participants will:

* Take a nasal decongestant or a placebo prior to surgery (just before anaesthesia is given)
* Be monitored during and after surgery in the post-anaesthesia care unit for any perioperative respiratory adverse events.
* Be asked about how acceptable they found the treatment.

Detailed description: Upper respiratory tract infections (URTI), including COVID-19 infection and the common cold, are common and frequent in children who present for elective surgery. Children with URTI are at a two-to-three-fold increased risk of perioperative respiratory adverse events (PRAE). PRAE are among the most serious and impactful consequences of paediatric anesthesia, including cardio-respiratory arrest, and therefore present a significant challenge for the pediatric anesthetist.

This two-phase, multicentre, international, double-blinded, randomised controlled trial aims to improve the safety of children with upper respiratory tract infections undergoing anesthesia by investigating the use of a nasal spray pre-operatively to reduce respiratory complications. Following informed written parental consent, 200 pediatric patients aged 1 to 8 years, undergoing general anesthesia for any surgery with current or recent URTI will be randomised to receive at the induction of anesthesia either a decongestant nasal spray or a placebo spray using the same bottle/actuator.

Monitoring and recording of PRAE (laryngospasm - closure of the vocal cords, bronchospasm - narrowing of the airways, severe and persistent coughing, airway obstruction, oxygen desaturation (\<95%) and postoperative stridor-squeaky noises when breathing) will occur throughout the procedure and in the post anesthesia care unit (PACU). We hypothesise that children who receive the nasal decongestant will be at a reduced risk of developing PRAE.

Eligibility criteria: Inclusion Criteria:

* Children aged 1 to 8.99 years with a current or recent upper respiratory tract infection (\<2 weeks).
* Undergoing interventions or surgery under general anesthesia (elective or urgent not emergency).

Exclusion Criteria:

* Currently taking nasal decongestants (past 24 hours) or receiving co-phenylocaine or decongestion for surgery.
* Surgery impacting the nasal airflow, e.g. adenoidectomy, cautery of inferior turbinates.
* Airway management with an endotracheal tube, face mask or high flow nasal oxygen.
* Known cardiovascular, respiratory or neurological disorders giving an ASA III or above.
* Thyroid disease.
* Diabetes.
* Known hypersensitivity to the interventional products.
* Department of Child Protection and Family Services involved in their care.
* Planned admissions to the Paediatric Intensive Care Unit (PICU).

Primary outcomes:
measure: Incidence of perioperative respiratory adverse event (PRAE) following the delivery of a nasal decongestant (Oxymetazoline 0.05%) or placebo prior to surgery under anesthesia in children with upper respiratory tract infection
timeFrame: On day of surgery: Perioperative period. PRAE will be assessed if it occurs anywhere along the perioperative pathway between the beginning of the patient's emergence from anesthesia and their discharge from the post-anesthetic care unit (PACU)
Secondary outcomes:
measure: Assess the incidence of severe PRAE during emergence or in PACU in children who received the decongestant spray compared to the control group.
timeFrame: Day of surgery: Perioperative period. Severe PRAE will be assessed if it occurs anywhere along the perioperative pathway between the beginning of the patient's emergence from anesthesia and their discharge from the post-anesthetic care unit (PACU)
measure: Assess the incidence of minor PRAE during emergence or in PACU inchildren who recieved the decongestant spray compared to the control group.
timeFrame: Day of surgery: Perioperative period. Minor PRAE will be assessed if it occurs anywhere along the perioperative pathway between the beginning of the patient's emergence from anesthesia and their discharge from the post-anesthetic care unit (PACU)
measure: Evaluate the acceptability of nasal decongestant use at the induction of anesthesia in children with upper respiratory tract infection aged 4 and older and their parents/guardians
timeFrame: Patients and parents/guardians will be asked to rate the intervention post-operatively, prior to their discharge from hospital.
measure: Evaluate the acceptability of nasal decongestant use at the induction of anesthesia by the treating anaesthetist
timeFrame: Treating anaesthetists will be asked to rate the intervention immediately after the administration of the interventional product.
measure: Incidence of any potential adverse effects related to the administration of the nasal decongestant/placebo
timeFrame: Any potential adverse effects will be assessed from the administration of the interventional product until the patient's discharge from hospital.
measure: Assessment of the successful administration of the interventional product in children
timeFrame: Successful administration of the interventional product will be assessed by the study team at induction of anesthesia, immediately following the administration or attempted administration of the nasal decongestant or placebo.
Other outcomes:
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