Trial Outcomes & Findings for Muscle Relaxation for Pediatric Adenotonsillectomy (NCT NCT06225466)

NCT ID: NCT06225466

Last Updated: 2025-07-28

Results Overview

Continuous outcome of intravenous morphine milligram equivalents (MME) per kg of body weight

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

172 participants

Primary outcome timeframe

From surgery start to discharge home, up to 24 hours

Results posted on

2025-07-28

Participant Flow

Participant milestones

Participant milestones
Measure
Neuromuscular Blockade
Rocuronium 0.6 mg/kg IV (max 50 mg) intraop with repeated doses of 0.2 mg/kg (max 15 mg) as indicated. Sugammadex 2-4 mg/kg IV at the end of surgery. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours after surgery. Monitoring: 1. Bispectral index system 2. TetraGraph neuromuscular transmission monitor 3. ExSpiron respiratory volume monitor in PACU Rocuronium: After induction of anesthesia and IV placement, administration of rocuronium 0.6 mg/kg (max 50 mg). Administration of additional doses of 0.2 mg/kg (max 15 mg) when TetraGraph indicates a train of four count of 2 or greater. Sugammadex: Administration of sugammadex 2 mg/kg at the end of surgery if the TetraGraph indicates the train of four count is 2 or greater. Sugammadex 4 mg/kg will be administered if 1) the train of four count is 1, or 2) if the train of four count is 0 and the post tetanic count is at least 1. There is no maximum dose of sugammadex.
No Neuromuscular Blockade
Anesthesia will be administered in a standard fashion. Rocuronium and sugammadex will not be administered. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance of anesthesia 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of the anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO every 6 hours beginning after surgery and alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours. Device monitoring: 1. Bispectral index system intraop 2. ExSpiron respiratory volume monitor intraop and in PACU Anesthesia without neuromuscular blockade: Anesthesia without rocuronium or sugammadex
Overall Study
STARTED
86
86
Overall Study
COMPLETED
86
86
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Unable to retrieve BIS values for 6 participants.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Neuromuscular Blockade
n=86 Participants
Rocuronium 0.6 mg/kg IV (max 50 mg) intraop with repeated doses of 0.2 mg/kg (max 15 mg) as indicated. Sugammadex 2-4 mg/kg IV at the end of surgery. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours after surgery. Monitoring: 1. Bispectral index system 2. TetraGraph neuromuscular transmission monitor 3. ExSpiron respiratory volume monitor in PACU Rocuronium: After induction of anesthesia and IV placement, administration of rocuronium 0.6 mg/kg (max 50 mg). Administration of additional doses of 0.2 mg/kg (max 15 mg) when TetraGraph indicates a train of four count of 2 or greater. Sugammadex: Administration of sugammadex 2 mg/kg at the end of surgery if the TetraGraph indicates the train of four count is 2 or greater. Sugammadex 4 mg/kg will be administered if 1) the train of four count is 1, or 2) if the train of four count is 0 and the post tetanic count is at least 1. There is no maximum dose of sugammadex.
No Neuromuscular Blockade
n=86 Participants
Anesthesia will be administered in a standard fashion. Rocuronium and sugammadex will not be administered. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance of anesthesia 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of the anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO every 6 hours beginning after surgery and alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours. Device monitoring: 1. Bispectral index system intraop 2. ExSpiron respiratory volume monitor intraop and in PACU Anesthesia without neuromuscular blockade: Anesthesia without rocuronium or sugammadex
Total
n=172 Participants
Total of all reporting groups
Age, Continuous
5.9 years
STANDARD_DEVIATION 2.9 • n=86 Participants
7 years
STANDARD_DEVIATION 3.2 • n=86 Participants
6.5 years
STANDARD_DEVIATION 3.1 • n=172 Participants
Sex: Female, Male
Female
39 Participants
n=86 Participants
42 Participants
n=86 Participants
81 Participants
n=172 Participants
Sex: Female, Male
Male
47 Participants
n=86 Participants
44 Participants
n=86 Participants
91 Participants
n=172 Participants
Race/Ethnicity, Customized
White
56 participants
n=86 Participants
54 participants
n=86 Participants
110 participants
n=172 Participants
Race/Ethnicity, Customized
Black
21 participants
n=86 Participants
17 participants
n=86 Participants
38 participants
n=172 Participants
Race/Ethnicity, Customized
Other
9 participants
n=86 Participants
15 participants
n=86 Participants
24 participants
n=172 Participants
Race/Ethnicity, Customized
Hispanic
50 participants
n=86 Participants
69 participants
n=86 Participants
119 participants
n=172 Participants
Race/Ethnicity, Customized
Non-Hispanic
36 participants
n=86 Participants
17 participants
n=86 Participants
53 participants
n=172 Participants
Obesity
37 Participants
n=86 Participants
54 Participants
n=86 Participants
91 Participants
n=172 Participants
Extreme prematurity
1 Participants
n=86 Participants
1 Participants
n=86 Participants
2 Participants
n=172 Participants
Upper respiratory infection symptoms
6 Participants
n=86 Participants
4 Participants
n=86 Participants
10 Participants
n=172 Participants
Trisomy 21
2 Participants
n=86 Participants
1 Participants
n=86 Participants
3 Participants
n=172 Participants
Obstructive sleep apnea severity
No preoperative polysomnogram
26 Participants
n=86 Participants
29 Participants
n=86 Participants
55 Participants
n=172 Participants
Obstructive sleep apnea severity
Mild obstructive sleep apnea
11 Participants
n=86 Participants
5 Participants
n=86 Participants
16 Participants
n=172 Participants
Obstructive sleep apnea severity
Moderate obstructive sleep apnea
6 Participants
n=86 Participants
9 Participants
n=86 Participants
15 Participants
n=172 Participants
Obstructive sleep apnea severity
Severe obstructive sleep apnea
43 Participants
n=86 Participants
43 Participants
n=86 Participants
86 Participants
n=172 Participants
Intraoperative bispectral index
52 index
STANDARD_DEVIATION 7 • n=84 Participants • Unable to retrieve BIS values for 6 participants.
48 index
STANDARD_DEVIATION 8 • n=82 Participants • Unable to retrieve BIS values for 6 participants.
50 index
STANDARD_DEVIATION 8 • n=166 Participants • Unable to retrieve BIS values for 6 participants.

PRIMARY outcome

Timeframe: From surgery start to discharge home, up to 24 hours

Continuous outcome of intravenous morphine milligram equivalents (MME) per kg of body weight

Outcome measures

Outcome measures
Measure
Neuromuscular Blockade
n=86 Participants
Rocuronium 0.6 mg/kg IV (max 50 mg) intraop with repeated doses of 0.2 mg/kg (max 15 mg) as indicated. Sugammadex 2-4 mg/kg IV at the end of surgery. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours after surgery. Monitoring: 1. Bispectral index system 2. TetraGraph neuromuscular transmission monitor 3. ExSpiron respiratory volume monitor in PACU Rocuronium: After induction of anesthesia and IV placement, administration of rocuronium 0.6 mg/kg (max 50 mg). Administration of additional doses of 0.2 mg/kg (max 15 mg) when TetraGraph indicates a train of four count of 2 or greater. Sugammadex: Administration of sugammadex 2 mg/kg at the end of surgery if the TetraGraph indicates the train of four count is 2 or greater. Sugammadex 4 mg/kg will be administered if 1) the train of four count is 1, or 2) if the train of four count is 0 and the post tetanic count is at least 1. There is no maximum dose of sugammadex.
No Neuromuscular Blockade
n=86 Participants
Anesthesia will be administered in a standard fashion. Rocuronium and sugammadex will not be administered. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance of anesthesia 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of the anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO every 6 hours beginning after surgery and alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours. Device monitoring: 1. Bispectral index system intraop 2. ExSpiron respiratory volume monitor intraop and in PACU Anesthesia without neuromuscular blockade: Anesthesia without rocuronium or sugammadex
Cumulative Intra- and Postoperative Opioid Consumption
0.209 IV morphine milligram equivalent/kg
Standard Error 0.009
0.188 IV morphine milligram equivalent/kg
Standard Error 0.009

SECONDARY outcome

Timeframe: From post-anesthesia care unit admission to discharge home, up to 24 hours

Population: Postoperative ward respiratory events measured by administration of questionnaires to nursing staff. Number analyzed represents number of participants with questionnaires returned. PACU respiratory events measured by bedside observation by study staff. No participants had outcome measurements missing from the PACU.

Composite binary outcome consisting of 1) airway obstruction or hypoxemia, defined as SpO2 \<90%, requiring any of the following interventions: supplemental oxygen by nasal cannula or simple face mask, noninvasive positive airway pressure, or reintubation; or 2) unanticipated ICU admission.

Outcome measures

Outcome measures
Measure
Neuromuscular Blockade
n=86 Participants
Rocuronium 0.6 mg/kg IV (max 50 mg) intraop with repeated doses of 0.2 mg/kg (max 15 mg) as indicated. Sugammadex 2-4 mg/kg IV at the end of surgery. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours after surgery. Monitoring: 1. Bispectral index system 2. TetraGraph neuromuscular transmission monitor 3. ExSpiron respiratory volume monitor in PACU Rocuronium: After induction of anesthesia and IV placement, administration of rocuronium 0.6 mg/kg (max 50 mg). Administration of additional doses of 0.2 mg/kg (max 15 mg) when TetraGraph indicates a train of four count of 2 or greater. Sugammadex: Administration of sugammadex 2 mg/kg at the end of surgery if the TetraGraph indicates the train of four count is 2 or greater. Sugammadex 4 mg/kg will be administered if 1) the train of four count is 1, or 2) if the train of four count is 0 and the post tetanic count is at least 1. There is no maximum dose of sugammadex.
No Neuromuscular Blockade
n=86 Participants
Anesthesia will be administered in a standard fashion. Rocuronium and sugammadex will not be administered. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance of anesthesia 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of the anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO every 6 hours beginning after surgery and alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours. Device monitoring: 1. Bispectral index system intraop 2. ExSpiron respiratory volume monitor intraop and in PACU Anesthesia without neuromuscular blockade: Anesthesia without rocuronium or sugammadex
Number of Participants With Postoperative Respiratory Events
Respiratory event PACU or ward
32 Participants
38 Participants
Number of Participants With Postoperative Respiratory Events
Respiratory event PACU
31 Participants
37 Participants
Number of Participants With Postoperative Respiratory Events
Respiratory event ward
4 Participants
10 Participants

SECONDARY outcome

Timeframe: From post-anesthesia care unit admission to transfer to the postoperative ward, up to 8 hours

Population: Two patients in the no neuromuscular blockade group were missing respiratory volume monitor data and therefore the measure of low MV events.

Count outcome of distinct episodes of low MV. MV - the product of respiratory rate and tidal volume - was continuously measured by a noninvasive respiratory volume monitor. Low MV events were defined as episodes of MV less than 40 percent predicted - calculated by the monitor based on the patient's body surface area - for at least two minutes. This definition is routinely used by the monitoring system.

Outcome measures

Outcome measures
Measure
Neuromuscular Blockade
n=86 Participants
Rocuronium 0.6 mg/kg IV (max 50 mg) intraop with repeated doses of 0.2 mg/kg (max 15 mg) as indicated. Sugammadex 2-4 mg/kg IV at the end of surgery. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours after surgery. Monitoring: 1. Bispectral index system 2. TetraGraph neuromuscular transmission monitor 3. ExSpiron respiratory volume monitor in PACU Rocuronium: After induction of anesthesia and IV placement, administration of rocuronium 0.6 mg/kg (max 50 mg). Administration of additional doses of 0.2 mg/kg (max 15 mg) when TetraGraph indicates a train of four count of 2 or greater. Sugammadex: Administration of sugammadex 2 mg/kg at the end of surgery if the TetraGraph indicates the train of four count is 2 or greater. Sugammadex 4 mg/kg will be administered if 1) the train of four count is 1, or 2) if the train of four count is 0 and the post tetanic count is at least 1. There is no maximum dose of sugammadex.
No Neuromuscular Blockade
n=84 Participants
Anesthesia will be administered in a standard fashion. Rocuronium and sugammadex will not be administered. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance of anesthesia 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of the anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO every 6 hours beginning after surgery and alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours. Device monitoring: 1. Bispectral index system intraop 2. ExSpiron respiratory volume monitor intraop and in PACU Anesthesia without neuromuscular blockade: Anesthesia without rocuronium or sugammadex
Number of Low Minute Ventilation (MV) Events in the Post-anesthesia Care Unit
0 low minute ventilation events
Interval 0.0 to 16.0
0 low minute ventilation events
Interval 0.0 to 5.0

Adverse Events

Neuromuscular Blockade

Serious events: 0 serious events
Other events: 1 other events
Deaths: 0 deaths

No Neuromuscular Blockade

Serious events: 0 serious events
Other events: 1 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Neuromuscular Blockade
n=86 participants at risk
Rocuronium 0.6 mg/kg IV (max 50 mg) intraop with repeated doses of 0.2 mg/kg (max 15 mg) as indicated. Sugammadex 2-4 mg/kg IV at the end of surgery. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours after surgery. Monitoring: 1. Bispectral index system 2. TetraGraph neuromuscular transmission monitor 3. ExSpiron respiratory volume monitor in PACU Rocuronium: After induction of anesthesia and IV placement, administration of rocuronium 0.6 mg/kg (max 50 mg). Administration of additional doses of 0.2 mg/kg (max 15 mg) when TetraGraph indicates a train of four count of 2 or greater. Sugammadex: Administration of sugammadex 2 mg/kg at the end of surgery if the TetraGraph indicates the train of four count is 2 or greater. Sugammadex 4 mg/kg will be administered if 1) the train of four count is 1, or 2) if the train of four count is 0 and the post tetanic count is at least 1. There is no maximum dose of sugammadex.
No Neuromuscular Blockade
n=86 participants at risk
Anesthesia will be administered in a standard fashion. Rocuronium and sugammadex will not be administered. SOC drugs: 1. Midazolam 0.5 mg/kg (max 15 mg) and acetaminophen 15 mg/kg (max 800 mg) PO 20-30 minutes before surgery. 2. Sevoflurane induction and maintenance of anesthesia 3. Dexamethasone 0.5 mg/kg IV (max 8 mg) intraop 4. Dexmedetomidine 0.3 mcg/kg IV (max 12 mcg) intraop 5. Fentanyl at the discretion of the anesthesiologist. In the post-anesthesia care unit (PACU), fentanyl 0.5 mcg/kg IV (max 25 mcg) for pain score 4 or greater (max 3 doses). 6. Ondansetron 0.1 mg/kg (max 4 mg) IV intraop 7. Ibuprofen 10 mg/kg (max 500 mg) PO every 6 hours beginning after surgery and alternating with acetaminophen 15 mg/kg (max 800 mg) every 6 hours. Device monitoring: 1. Bispectral index system intraop 2. ExSpiron respiratory volume monitor intraop and in PACU Anesthesia without neuromuscular blockade: Anesthesia without rocuronium or sugammadex
Respiratory, thoracic and mediastinal disorders
Drug reaction
1.2%
1/86 • 24 hours
Adverse events collected through regular investigator assessment.
0.00%
0/86 • 24 hours
Adverse events collected through regular investigator assessment.
Respiratory, thoracic and mediastinal disorders
Drug effect
0.00%
0/86 • 24 hours
Adverse events collected through regular investigator assessment.
1.2%
1/86 • 24 hours
Adverse events collected through regular investigator assessment.

Additional Information

Dr. Proshad Efune

University of Texas Southwestern Medical Center

Phone: 2144566393

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place