Interaction of Volatile Anesthetics With Magnesium

NCT ID: NCT05261516

Last Updated: 2024-05-10

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

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

96 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-11-18

Study Completion Date

2025-08-31

Brief Summary

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Magnesium and volatiles anesthetics both have an effect on the neuromuscular transmission. The primary objective of the study is to quantify the effect of a perfusion of intravenous magnesium on neuromuscular transmission measured by electromyography device TetraGraph device in patients undergoing general anesthesia with volatile anesthetics (desflurane, sevoflurane and isoflurane) as compared to intravenous anesthesia with propofol.

Detailed Description

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Magnesium sulfate is regularly used during anesthesia, for instance for the reduction of postoperative pain. It reduces the liberation of acetylcholine at the neuromuscular junction. At high plasma concentrations it can induce muscle weakness, flaccid paralysis and in cases of intoxication lead to respiratory arrest. It enhances the effect of muscle relaxants.

Volatiles anesthetics influence neuromuscular transmission. They inhibit postsynaptic nicotinic acetylcholine receptors by causing open channel block, receptor desensitization and reducing exocytosis from pre-synaptic vesicles at the neuromuscular junction. The ranking order of these effects of volatile anesthetics on neuromuscular transmission is: desflurane \> sevoflurane \> isoflurane, depending on their blood-gas and tissue-gas solubility index.

Magnesium given intravenously during volatile anesthesia induces effects on neuromuscular transmission similar to that of neuromuscular blocking agents. This effect has never been investigated and quantified systematically and prospectively.

Propofol, an intravenous anesthetic, has very little effects on neuromuscular transmission. Therefore magnesium given intravenously during total intravenous anesthesia with propofol has no or only very little effect on neuromuscular transmission.

The primary objective of the study is to quantify the effect of a perfusion of intravenous magnesium on neuromuscular transmission measured by accelerometry with theTetraGraph device in patients undergoing general anesthesia with volatile anesthetics (desflurane, sevoflurane and isoflurane) as compared to intravenous anesthesia with propofol. The investigators expect a following rank order of the effect: desflurane \> sevoflurane \> isoflurane \> propofol.

Conditions

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Neuromuscular Blockade

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study is a three centers prospective randomized, electrophysiological, single blinded study that will include 96 patients allocated to one of four arms: one arm with propofol anesthesia and three arms with volatile anesthetics (one arm with isoflurane, one with sevoflurane and one with desflurane). Each arm will have 24 patients.
Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Participants
For practical reasons it is impossible to blind the investigator who conducts the anesthesia. However, the parameters of neuromuscular block are standardized, and study outcomes will be evaluated using the data stored and displayed in theTetraGraph Viewer software. All neuromuscular measurements of the study outcomes are reproducible and objective.

In contrast, the investigator evaluating the patient in the postanesthetic care unit and for the 24 h postoperative visit will be blinded to the study group allocation.

The patient will also be blinded to the study group allocation.

Study Groups

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Propofol

In all patients 3 minutes before induction sufentanil 0.2 mcg/kg or fentanyl 2 mcg/kg will be given.

In patients in the propofol group, anesthesia will be induced and maintained with a total intravenous anesthesia pump following the model of Schnider et al, at a targeted effect-site concentration of 4 +/- 1 mcg/ml.

In patients in all groups, after induction of anesthesia and loss of consciousness, a laryngeal mask airway will be inserted. The TetraGraph device will be calibrated. Once general anesthesia is established, a blood sample will be taken to measure serum magnesium and calcium levels. This blood sample will be analysed in the certified laboratory of each participating hospital.

Group Type ACTIVE_COMPARATOR

Magnesium Sulfate

Intervention Type DRUG

The experimental intervention is the injection of magnesium sulfate. This will be done as soon as TetraGraph calibration is done and neuromuscular measurements are stable. Each patient will receive 60 mg/kg of magnesium sulfate as an intravenous perfusion over 5 minutes. Vital signs before, during and after the perfusion will be taken and documented.

Isoflurane

In all patients 3 minutes before induction sufentanil 0.2 mcg/kg or fentanyl 2 mcg/kg will be given. After induction of anesthesia and loss of consciousness, a laryngeal mask airway will be inserted. The TetraGraph device will be calibrated. Once general anesthesia is established, a blood sample will be taken to measure serum magnesium and calcium levels. This blood sample will be analysed in the certified laboratory of each participating hospital.

The anesthesia will be maintained with the agent specified by randomization: isoflurane in this group.

Group Type EXPERIMENTAL

Magnesium Sulfate

Intervention Type DRUG

The experimental intervention is the injection of magnesium sulfate. This will be done as soon as TetraGraph calibration is done and neuromuscular measurements are stable. Each patient will receive 60 mg/kg of magnesium sulfate as an intravenous perfusion over 5 minutes. Vital signs before, during and after the perfusion will be taken and documented.

Desflurane

In all patients 3 minutes before induction sufentanil 0.2 mcg/kg or fentanyl 2 mcg/kg will be given. After induction of anesthesia and loss of consciousness, a laryngeal mask airway will be inserted. The TetraGraph device will be calibrated. Once general anesthesia is established, a blood sample will be taken to measure serum magnesium and calcium levels. This blood sample will be analysed in the certified laboratory of each participating hospital.

The anesthesia will be maintained with the agent specified by randomization: desflurane in this group.

Group Type EXPERIMENTAL

Magnesium Sulfate

Intervention Type DRUG

The experimental intervention is the injection of magnesium sulfate. This will be done as soon as TetraGraph calibration is done and neuromuscular measurements are stable. Each patient will receive 60 mg/kg of magnesium sulfate as an intravenous perfusion over 5 minutes. Vital signs before, during and after the perfusion will be taken and documented.

Sevoflurane

In all patients 3 minutes before induction sufentanil 0.2 mcg/kg or fentanyl 2 mcg/kg will be given. After induction of anesthesia and loss of consciousness, a laryngeal mask airway will be inserted. The TetraGraph device will be calibrated. Once general anesthesia is established, a blood sample will be taken to measure serum magnesium and calcium levels. This blood sample will be analysed in the certified laboratory of each participating hospital.

The anesthesia will be maintained with the agent specified by randomization: sevoflurane in this group.

Group Type EXPERIMENTAL

Magnesium Sulfate

Intervention Type DRUG

The experimental intervention is the injection of magnesium sulfate. This will be done as soon as TetraGraph calibration is done and neuromuscular measurements are stable. Each patient will receive 60 mg/kg of magnesium sulfate as an intravenous perfusion over 5 minutes. Vital signs before, during and after the perfusion will be taken and documented.

Interventions

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Magnesium Sulfate

The experimental intervention is the injection of magnesium sulfate. This will be done as soon as TetraGraph calibration is done and neuromuscular measurements are stable. Each patient will receive 60 mg/kg of magnesium sulfate as an intravenous perfusion over 5 minutes. Vital signs before, during and after the perfusion will be taken and documented.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients, age 18 to 65 years inclusive
* American Society of Anesthesiology \[ASA\] status I or II
* Body mass index 19 - 30 kg/m2
* Patient scheduled for elective surgery lasting ≥ 60 minutes
* Patient is able to read and understand the information sheet and to sign and date the consent form.
* Negative urinary or serum pregnancy test (not applicable if status post hysterectomy or tubal ligation or menopausal woman)

Exclusion Criteria

* Surgery with need for neuromuscular block
* Contraindication for general anesthesia with laryngeal mask airway, such as gastro-oesophageal reflux.
* Hypersensitivity or allergy to magnesium sulfate or propofol
* Contraindication to volatile anesthetics such as malignant hyperthermia
* Patients with neuromuscular disease
* Patients receiving medications known to influence neuromuscular function (for instance, aminoglycosides or phenytoine)
* Known electrolyte abnormalities (for instance, hypermagnesemia)
* Atrioventricular heart block
* Patients with magnesium treatment within 48 hours before start of study
* Liver insufficiency (bilirubine \<1.5x, ALAT/ASAT\<2.5x the upper limit of normal value)
* Renal insuffisancy (créatinine \<1.5x upper limit of normal value, clearance\<30ml/minute)
* Patient having participated in any clinical trial within 30 days, inclusive, of signing the informed consent form of the current trial.
* Pregnant or breast-feeding women.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Centre Hospitalier du Centre du Valais

OTHER

Sponsor Role collaborator

Ospedale Regionale di Lugano

OTHER

Sponsor Role collaborator

Christoph Czarnetzki

OTHER

Sponsor Role lead

Responsible Party

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Christoph Czarnetzki

Consultant

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Department of Anesthesiology and Intensive Care, Valais Hospital

Sion, , Switzerland

Site Status RECRUITING

Countries

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Switzerland

Central Contacts

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Christoph Czarnetzki, MD, MBA

Role: CONTACT

+41 091 8116664

Sina Grape, MD, MBA

Role: CONTACT

0041276038759

Facility Contacts

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Sina Grape, MD, MBA

Role: primary

Other Identifiers

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2019-02104/CE3541

Identifier Type: -

Identifier Source: org_study_id

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