Surgical Conditions During Vocal Cord Surgery Requiring Jet Ventilation With Moderate vs. Deep Neuromuscular Block

NCT ID: NCT02888067

Last Updated: 2023-10-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE1

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-07-01

Study Completion Date

2022-07-20

Brief Summary

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The purpose of this study is to determine whether deep neuromuscular blockade provides better surgical conditions than moderate neuromuscular blockade in patients undergoing vocal cord resections requiring jet ventilation.

Detailed Description

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To optimize anatomical exposure and to minimize direct manipulation of local lesions endotracheal intubation often is avoided in patients undergoing vocal cord surgery.

Instead intermittent so called jet ventilation is carried out by using the Hunsaker Mon-jet tube. The safe conduct of these procedures requires full muscle paralysis. In clinical practice, however, deep neuromuscular blockade (NMB) usually cannot be established for this relatively short surgery (\<1h) because of an increased risk of prolonged NMB and postoperative ventilation.

The novel neuromuscular blockade reversal agent sugammadex may prove particularly useful in this patient population because it allows fast and reliable reversal of even deep NMB. Deeper muscle paralysis during vocal cord surgery may be associated with better surgical conditions.

The purpose of this study is to determine whether deep neuromuscular blockade provides better surgical conditions than moderate neuromuscular blockade in patients undergoing vocal cord resections requiring jet ventilation.

Conditions

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High-Frequency Jet Ventilation Vocal Cord Resection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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Moderate neuromuscular blockade (MNB)

The goal is to realize a moderate NMB (TOF 1-2 twitches). NMB will be induced with a bolus dose of rocuronium (Non-depolarizing Skeletal Neuromuscular Blocking Agent). If the target TOF values was not reached bolus doses of rocuronium (5 mg) will be given to achieve the target.

This represents the standard care in our institution for this type of surgery. At the end of surgery, neuromuscular blockade in all patients will be reversed by sugammadex: patients in the moderate neuromuscular blockade group will receive sugammadex (Selective Relaxant Binding Agent).

Group Type ACTIVE_COMPARATOR

Rocuronium bromide 0.5 mg/kg

Intervention Type DRUG

Moderate neuromuscular blockade with rocuronium bromide

Sugammadex sodium 2 mg/kg

Intervention Type DRUG

Reversal with sugammadex sodium

Deep neuromuscular blockade (MNB)

The goal is to realize a deep MNB (TOF zero twitches). NMB will be induced with a bolus dose of rocuronium (Non-depolarizing Skeletal Neuromuscular Blocking Agent). If the target TOF values was not reached bolus doses of rocuronium (5 mg) will be given to achieve the target.

At the end of surgery, neuromuscular blockade in all patients will be reversed by sugammadex: patients in the deep neuromuscular blockade group will receive sugammadex (Selective Relaxant Binding Agent).

Group Type ACTIVE_COMPARATOR

Rocuronium bromide 1.0 mg/kg

Intervention Type DRUG

Deep neuromuscular blockade with rocuronium bromide

Sugammadex sodium 4 mg/kg

Intervention Type DRUG

Reversal with sugammadex sodium

Interventions

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Rocuronium bromide 0.5 mg/kg

Moderate neuromuscular blockade with rocuronium bromide

Intervention Type DRUG

Rocuronium bromide 1.0 mg/kg

Deep neuromuscular blockade with rocuronium bromide

Intervention Type DRUG

Sugammadex sodium 2 mg/kg

Reversal with sugammadex sodium

Intervention Type DRUG

Sugammadex sodium 4 mg/kg

Reversal with sugammadex sodium

Intervention Type DRUG

Other Intervention Names

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Zemuron® Zemuron® Bridion™ Bridion™

Eligibility Criteria

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Inclusion Criteria

* Elective vocal cord resection with an expected length of the procedure longer than 20 minutes and requiring jet ventilation

Exclusion Criteria

* Patients younger than 18 years old
* Patients unable to give written informed consent
* Patients with known or suspected neuromuscular disease
* Patients with allergies to medications to be used during anesthesia
* Patients with a (family) history of malignant hyperthermia
* Patients with renal insufficiency (serum creatinine \>2 times normal or a glomerular filtration rate \<60 ml/h)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Merck Sharp & Dohme LLC

INDUSTRY

Sponsor Role collaborator

Thomas Schricker

OTHER

Sponsor Role lead

Responsible Party

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Thomas Schricker

Professor and Chairman,Department of Anesthesia

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Thomas Schricker, M.D., PhD.

Role: PRINCIPAL_INVESTIGATOR

McGill University Health Centre/Research Institute of the McGill University Health Centre

Locations

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MUHC

Montreal, Quebec, Canada

Site Status

Countries

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Canada

Other Identifiers

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2017-2754

Identifier Type: -

Identifier Source: org_study_id

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