- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03146767
The Staircase Phenomenon Implications on Neuromuscular Block Monitoring
May 5, 2017 updated by: Oscar Diaz-Cambronero, Hospital Universitario La Fe
The Staircase Phenomenon and His Implications on Neuromuscular Block Monitoring During General Anesthesia
The staircase phenomenon could have repercussions on the onset and recovery time following administration of a neuromuscular blocking agent.
The investigators aim to assess the magnitude of the staircase phenomenon and its impact on various aspects of neuromuscular blockade with a randomized controlled double blind trial.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
50
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Valencia, Spain
- Hospital Universitario La Fe
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- ASA (American Society of Anesthesiology surgical risk scale) grade I - II
- Surgery not involving airway performed under general anaesthesia with neuromuscular blocker
Exclusion Criteria:
- Pregnancy
- BMI (Body Mass Idex) > 35 Kg/m2
- Anticipated difficult airway
- Chronic kidney or hepatic failure
- Neuromuscular disease
- Medication that has known interactions with neuromuscular blockers
- Hemodynamic failure
- Anticipated large blood loss
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: OTHER
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Tetanic Group
A Tetanic stimulation (Tetanus stabilization of baseline) is administered to the monitorized arm before calibrating the neuromuscular block monitor.
Then Train-of-four (TOF) stimuli are administered every 20 seconds for 20 minutes.
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Administering a Tetanic stimulus before baseline stabilization shortens the stabilization period of baseline of a neuromuscular block monitor.
This acts on the baseline value
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NO_INTERVENTION: Control Group
Conventional monitor baseline stabilization: Train-of-four stimuli are administered every 20 seconds for 20 minutes
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in Block Onset time difference (seconds)
Time Frame: rom 0 seconds up to 240 seconds after neuromuscular block administration at the beginning of surgery. Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Onset time is the time between Train of Four (TOF) at the moment of injection of neuromuscular blocking drug and the minimum value reached (onset of neuromuscular block)
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rom 0 seconds up to 240 seconds after neuromuscular block administration at the beginning of surgery. Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in time until recovery of a TOF ratio (TOFr) of 0.9
Time Frame: From administration of neuromuscular blocking drug until spontaneous reversal (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Time until recovery of a TOF ratio of 0.9 (reversal of neuromuscular block as assessed by the monitor).
During recovery phase stimuli regain height until all four stimuli of the Train-of-Four are present.
Train-of-Four ratio is the ratio between the fourth and the first stimuli (T4/T1).
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From administration of neuromuscular blocking drug until spontaneous reversal (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Difference in TOFr 0.9 Normalized
Time Frame: From administration of neuromuscular blocking drug until spontaneous reversal at this specified point (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Time until recovery of a TOF ratio of 0.9 normalized to baseline TOR ratio after calibration.
(e.g. if baseline TOF ratio is 1.1, normalized TOF ratio 0.9 is: 1.1 x 0.9 = 0.99)
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From administration of neuromuscular blocking drug until spontaneous reversal at this specified point (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Difference in time until recovery of 25% of maximum twitch height ot T1 stimulus (DUR25)
Time Frame: From administration of neuromuscular blocking drug until spontaneous reversal at this specified point (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery.(up to 4 hours)
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Difference in time until recovery of 25% of maximum twitch height ot T1 stimulus during recovery phase.
During recovery phase stimuli begin to recover and their height increases.
This outcome is the time between the beginning of neuromuscular block until recovery of 25% of height of the first stimulus of the Train-of-Four.recovery
phase.
During recovery phase stimuli begin to recover and their height increases.
This outcome is the time between the beginning of neuromuscular block until recovery of 25% of height of the first stimulus of the Train-of-Four (TOF)
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From administration of neuromuscular blocking drug until spontaneous reversal at this specified point (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery.(up to 4 hours)
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Time between 25% and 75% of maximum twitch height recovery of T1 stimulus
Time Frame: From administration of neuromuscular blocking drug until spontaneous reversal (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Time between 25% and 75% height recovery of maximum twitch height in the recovery phase.
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From administration of neuromuscular blocking drug until spontaneous reversal (up to 4 hours). Time frame is the duration of general anesthesia before, during and after surgery (up to 4 hours).
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Difference between first stimulus of Train-of-Four ratio at baseline
Time Frame: Single measurement of muscle response after calibration procedure at the beginning of data recording after randomization. It is not a time-to-event variable
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Difference between T1 at baseline.
Train-of-Four ratio is the administration of four consecutive stimuli to the monitored muscle.
These stimuli are named T1,T2,T3,T4.
This is the difference between tow arms oh T1 height at baseline
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Single measurement of muscle response after calibration procedure at the beginning of data recording after randomization. It is not a time-to-event variable
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Difference between T1 height after stabilization period of 20 minutes
Time Frame: Single measurement after 20 minutes stabilization period after beginning of neuromuscular stimulation. It is not a time-to-event variable
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Difference between T1 height after stabilization period of 20 minutes
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Single measurement after 20 minutes stabilization period after beginning of neuromuscular stimulation. It is not a time-to-event variable
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Difference between TOF ratio at baseline time
Time Frame: Single measurement of muscle response after calibration procedure at the beginning of data recording.
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Difference between TOF ratio at baseline time
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Single measurement of muscle response after calibration procedure at the beginning of data recording.
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Difference between TOF ratio after stabilization period time
Time Frame: Single measurement after 20 minutes stabilization period after beginning of neuromuscular stimulation.
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Difference between TOF ratio after stabilization period time
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Single measurement after 20 minutes stabilization period after beginning of neuromuscular stimulation.
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Monitor Sensitivity difference between groups
Time Frame: Single value no time frame. Sensitivity is internally set by the monitor during calibration (at the beginning of data recording after randomization)
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Sensitivity parameter is set by monitor after calibration.
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Single value no time frame. Sensitivity is internally set by the monitor during calibration (at the beginning of data recording after randomization)
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Monitor Amperage Intensity after calibration difference (milliAmperes, mA)
Time Frame: Single value no time frame. Sensitivity is internally set by the monitor during calibration (at the beginning of data recording after randomization)
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Monitor Amperage Intensity is set by the monitor after calibration
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Single value no time frame. Sensitivity is internally set by the monitor during calibration (at the beginning of data recording after randomization)
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T1/TOFratio relationship difference
Time Frame: Ratio of specified values recorded by the monitor at the beginning of surgery until onset of neuromuscular block (up to 180 seconds) and during spontaneous recovery up to 4 hours until end of anesthesia
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During recovery phase T1 over TOF ratio will be calculated and the difference between two groups will be assessed.
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Ratio of specified values recorded by the monitor at the beginning of surgery until onset of neuromuscular block (up to 180 seconds) and during spontaneous recovery up to 4 hours until end of anesthesia
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
February 1, 2013
Primary Completion (ACTUAL)
March 1, 2014
Study Completion (ACTUAL)
March 1, 2014
Study Registration Dates
First Submitted
April 25, 2017
First Submitted That Met QC Criteria
May 5, 2017
First Posted (ACTUAL)
May 10, 2017
Study Record Updates
Last Update Posted (ACTUAL)
May 10, 2017
Last Update Submitted That Met QC Criteria
May 5, 2017
Last Verified
May 1, 2017
More Information
Terms related to this study
Other Study ID Numbers
- MAZ0816
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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