Residual Neuromuscular Blockade
Conditions
Keywords
Neuromuscular blockade reversal, TOF ratio, Calcium chloride
Brief summary
The purpose of this study is to evaluate the effect of calcium chloride against residual neuromuscular blockade at the end of general anesthesia
Detailed description
During general anesthesia, neuromuscular blocking agent is administered to facilitate endotracheal intubation and the view of operative field. The neuromuscular blockade should be reversed at the end of anesthesia to recover spontaneous breathing of the patient. Residual neuromuscular blockade (RNMB) is defined as train of-four ratio \< 0.9. RNMB is a risk factor for postoperative pulmonary complication and increases postoperative mortality. Neostigmine is acetylcholinesterase inhibitor routinely used at the end of anesthesia to prevent RNMB. A meta-analysis, however, showed that 40 percent of patients who received intermediate-acting neuromuscular blocking agent during anesthesia showed RNMB in PACU. Calcium triggers the release of acetylcholine from the motor nerve terminal and enhances excitation-contraction coupling in muscle. Increasing calcium concentrations decreased the sensitivity to dTc and pancuronium in an animal muscle-nerve model. The effect of calcium chloride on residual neuromuscular blockade is not studied yet. The purpose of this study is to evaluate the effect of calcium chloride on residual neuromuscular blockade at the end of general anesthesia
Interventions
DRUGCalcium
Administration of calcium chloride 5 mg/kg along with neostigmine 25 mcg/kg + atropine 15 mcg/kg
DRUGcontrol
In the control group, all the procedures were the same with calcium group, except for the fact that calcium chloride is not administered
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* 18-65 yr * Body mass index 15.0-25.0 kg/m2 * American Society of Anesthesiologists physical status I-III * Scheduled for elective surgery with an expected duration of more than 60 min under general anesthesia with endotracheal intubation
Exclusion criteria
* Suspected difficulty airway * Bronchial asthma, chronic obstructive pulmonary disease * Neuromuscular disease * Hepatic or renal dysfunction. * Taking medications that might influence the effect of neuromuscular blocking agents * Allergy to the medication that used in this trial * Pregnant, or breastfeeding state * Suspected malignant hyperthermia * Contraindication to the medication that used in this trial * Hypercalcemia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to train of-four ratio of 0.9. | At 10 minutes (expected aeverage) after the surgery | Train of-four will be measured using acceleromyograph. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Train of-four ratio | At 5, 10, 20 minutes after the administration of reversal drug | Train of-four will be measured using accelerography. |
| Length of PACU stay | At 60 minutes (expected average) after the surgery | — |
Countries
South Korea
Outcome results
None listed