Algorithm of Muscle Function Tests to Detect Residual Neuromuscular Blockade.

NCT ID: NCT03219138

Last Updated: 2017-07-17

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

COMPLETED

Clinical Phase

NA

Total Enrollment

265 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-01-08

Study Completion Date

2009-07-25

Brief Summary

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Objective neuromuscular monitoring is the gold standard to detect postoperative residual curarization (PORC). Many anesthesiologist just use qualitative neuromuscular monitoring or unreliable, clinical tests. Goal of this study is to develop an algorithm of muscle function tests to identify PORC

Detailed Description

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Background: Quantitative neuromuscular monitoring is the gold standard to detect postoperative residual curarization (PORC). Many anesthesiologists, however, use insensitive, qualitative neuromuscular monitoring or unreliable, clinical tests. Goal of this multicentre, prospective, double-blinded, assessor controlled study is to develop an algorithm of muscle function tests to identify PORC.

Methods: After extubation a blinded anesthetist performs eight clinical tests in 165 patients. Test results are correlated to calibrated electromyography train-of-four (TOF) ratio and to a postoperatively applied uncalibrated acceleromyography. A classification and regression tree (CART) is calculated developing the algorithm to identify PORC. This is validated against uncalibrated acceleromyography and tactile judgement of TOF fading in separate 100 patients.

Conditions

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Postoperative Residual Curarization

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

During anaesthesia calibrated neuromuscular function is monitored using evoked EMG of the adductor pollicis muscle (immobilised forearm) with a NMT module by a non-blinded investigator. During surgery, the (blinded) attending anaesthesiologist administers maintenance doses of atracurium according to clinical needs, i.e. without knowing the TOFR.

After surgery patients' trachea is extubated according to clinical judgement. Immediately after extubation blinded anaesthesiologist tests the patient. The postoperative evaluation of neuromuscular function consists of eight clinical tests applied in a random order.

Thereafter, an uncalibrated acceleromyography (50 mA, 2 Hz) is started on the contralateral arm and TOF ratio is measured.

During the validation part of the developed algorithm the anaesthesiologist additionally had to judge tactile fading of the adductor pollicis.

If a patient had any clinical signs of neuromuscular dysfunction, reversal with neostigmine is administered.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Caregivers
Immediately after extubation the blinded anaesthesiologist (care provider), who performs anesthesia, tests the patient in the operating room.

The blinded anaesthesiologist is unable to see the data on the EMG monitor and the movement of the adductor pollicis muscle.

Study Groups

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Electromyography

Neuromuscular function was monitored, using evoked electromyography of the adductor pollicis muscle with a neuromuscular transmission module by a non-blinded investigator.

Group Type NO_INTERVENTION

No interventions assigned to this group

Acceleromyography

Immediately after extubation the blinded anaesthesiologist tested with an uncalibrated acceleromyography on the contralateral arm.

Group Type EXPERIMENTAL

Acceleromyography

Intervention Type DEVICE

Use of an uncalibrated acceleromyography

Interventions

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Acceleromyography

Use of an uncalibrated acceleromyography

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* laparoscopic abdominal procedures
* orthopedic
* minor visceral surgery

Exclusion Criteria

* participation in another study
* body mass index over 30
* history of neuromuscular diseases
* gastro-esophageal reflux disease.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Technical University of Munich

OTHER

Sponsor Role collaborator

University Hospital Muenster

OTHER

Sponsor Role collaborator

University Hospital Schleswig-Holstein

OTHER

Sponsor Role collaborator

Johannes Gutenberg University Mainz

OTHER

Sponsor Role collaborator

University of Regensburg

OTHER

Sponsor Role lead

Responsible Party

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Christoph Unterbuchner

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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6Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel,

Kiel, , Germany

Site Status

Klinik für Anaesthesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz

Mainz, , Germany

Site Status

Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster

Münster, , Germany

Site Status

Klinik für Anaesthesiologie und operative Intensivmedizin, Klinikum am Steinenberg, Steinenbergstr. 31, 72764 Reutlingen, Germany

Reutlingen, , Germany

Site Status

Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Rostock

Rostock, , Germany

Site Status

Countries

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Germany

References

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Baillard C, Clec'h C, Catineau J, Salhi F, Gehan G, Cupa M, Samama CM. Postoperative residual neuromuscular block: a survey of management. Br J Anaesth. 2005 Nov;95(5):622-6. doi: 10.1093/bja/aei240. Epub 2005 Sep 23.

Reference Type BACKGROUND
PMID: 16183681 (View on PubMed)

Baillard C, Bourdiau S, Le Toumelin P, Ait Kaci F, Riou B, Cupa M, Samama CM. Assessing residual neuromuscular blockade using acceleromyography can be deceptive in postoperative awake patients. Anesth Analg. 2004 Mar;98(3):854-7, table of contents. doi: 10.1213/01.ane.0000100150.84698.8c.

Reference Type BACKGROUND
PMID: 14980952 (View on PubMed)

Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J; 8th International Neuromuscular Meeting. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007 Aug;51(7):789-808. doi: 10.1111/j.1399-6576.2007.01352.x.

Reference Type BACKGROUND
PMID: 17635389 (View on PubMed)

Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, Nakatsuka I, Takeda J. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesth Analg. 2013 Aug;117(2):345-51. doi: 10.1213/ANE.0b013e3182999672. Epub 2013 Jun 11.

Reference Type BACKGROUND
PMID: 23757472 (View on PubMed)

Unterbuchner C, Blobner M, Puhringer F, Janda M, Bischoff S, Bein B, Schmidt A, Ulm K, Pithamitsis V, Fink H. Development of an algorithm using clinical tests to avoid post-operative residual neuromuscular block. BMC Anesthesiol. 2017 Aug 4;17(1):101. doi: 10.1186/s12871-017-0393-4.

Reference Type DERIVED
PMID: 28778151 (View on PubMed)

Other Identifiers

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N° 1783/ 07

Identifier Type: -

Identifier Source: org_study_id

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