- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03371953
Evaluation of Atracurium-vecuronium Combination in Laparosocpic Surgery
Efficacy of Atracurium-vecuronium Combination in Patients Undergoing Laparoscopic Surgery:a Randomised Controlled Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The principal pharmacological effect of neuromuscular blocking drugs is to interrupt the transmission of nerve impulses at the neuromuscular junction. They are classified into depolarising (mimics the action of acetylcholine) and non-depolarising (interfere with the action of acetylcholine).In general, we use vecuronium (0.08mg/kg) or atracurium (0.5mg/kg), which are intermediate-acting non-depolarising neuromuscular blocking agents for skeletal muscle relaxation.
The main use of neuromuscular blocking drugs is to provide skeletal muscle relaxation for facilitation of intubation of the trachea and to improve surgical working conditions in the anaesthetised patients. A 2×ED95 dose of non-depolarising muscle relaxant is recommended to facilitate tracheal intubation. In practice, 90% suppression of the single twitch response is usually considered clinical evidence of adequate drug-induced skeletal muscle relaxation.
Laparoscopy has become the most preferred means of surgical access for a variety of procedures. There are many laparoscopic surgeries that last about an hour. But the duration-of-action of bolus (intubating) dose of atracurium or vecuronium when used alone is not sufficient to last for an hour. As a result, for surgeries lasting an hour(e.g. laparoscopic cholecystectomy, laparoscopic total extra-peritoneal repair, etc.), one either end up giving a top up (maintenance) dose of vecuronium/atracurium to extend muscle relaxation or withhold the add-on dose and continue with surgery towards completion. While in the former situation, the anaesthesiologist is required to wait for long even though the surgery is completed; in the latter, either the surgery gets disturbed due to patient's movement (e.g. coughing, bucking) or there may be associated hemodynamic activation, which requires deepening of anaesthesia plane; both harbinger for patient-related adversity.
There are studies which have evaluated the effect of combining two non-depolarizing neuromuscular relaxants on the profile of skeletal muscle relaxation pertinent to anaesthetic (tracheal intubation) and surgical conditions.Atracurium and vecuronium are the most common non- depolarizing muscle relaxants we routinely employ during general anaesthesia (GA). Till date, to our knowledge, there are a very few studies that have evaluated combination of atracurium and vecuronium given together.Though, the limited number of studies which analysed effects of combined neuromuscular relaxation with atracurium and vecuronium underlined that there is an additive effect, commented only on onset-of-action and reversibility of muscle relaxation effect. In addition, no study has yet evaluated the duration-of-action of atracurium- vecuronium combination in adults undergoing laparoscopic surgeries. Muscle relaxation is used for optimising laparoscopic operating conditions by preventing diaphragmatic movement due to irritation by the presence of pneumoperitoneum and achieving more intra-abdominal space for a particular intra-abdominal insufflation pressure. In this context, deeper than normally maintained level of neuromuscular blockade appears to be superior. The investigators contend that combining vecuronium and atracurium would not only facilitate increase in duration-of-action of the relaxation but also provide quality muscle relaxation for the duration of surgery.
The proposed study looks forward to analyse the effect of muscle relaxation profile of vecuronium-atracurium combination versus vecuronium-alone or atracurium-alone in patients undergoing laparoscopic surgery.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Amitabh Dutta, MD,PGDHR
- Phone Number: 00919810848064
- Email: duttaamiatbh@yahoo.co.in
Study Contact Backup
- Name: Palem Reshmika
- Phone Number: 00919773587847
- Email: reshmika.palem@gmail.com
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110060
- Sir Ganga Ram Hospital
-
Contact:
- Amitabh Dutta, MD, PGDHR
- Phone Number: 00919810848064
- Email: duttaamiatbh@yahoo.co.in
-
Contact:
- Palem Reshmika, MBBS
- Phone Number: 00919773587847
- Email: reshmika.palem@gmail.com
-
Principal Investigator:
- Amitabh Dutta, MD,PGDHR
-
Sub-Investigator:
- Palem Reshmika, MBBS
-
Principal Investigator:
- Savitar Malhotra, MD
-
Sub-Investigator:
- Subhash Gupta, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ASA physical status I and II
- Laparoscopic surgeries likely to last for 1 hour duration
Exclusion Criteria:
- Patient refusal
- ASA physical status III and IV
- History of hypersensitivity to atracurium or vecuronium
- Alcoholism and drug addiction
- Neuromuscular disorders
- Neuropsychiatric patients
- Hepatic and renal disease patients
- Obese patients
- Abnormal airway anatomy
- Risk of oesophageal reflux
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Vecuronium group
Vecuronium 0.08 mg/kg will be administered at induction of anaesthesia for facilitating muscle relaxation
|
A top-up dose of vecuronium will be administered when the TOF count is 1 on the accelerometer.
However, if there is a diaphragmatic contraction which interferes with surgical procedure then a dose will be given irrespective of the TOF count.
|
Active Comparator: Atracurium group
Atracurium 0.6 mg/kg will be administered at induction of anaesthesia for facilitating muscle relaxation
|
A top-up dose of vecuronium will be administered when the TOF count is 1 on the accelerometer.
However, if there is a diaphragmatic contraction which interferes with surgical procedure then a dose will be given irrespective of the TOF count.
|
Active Comparator: Vecuronium-Atracurium group
Vecuronium 0.04 mg/kg + atracurium 0.3 mg/kg will be administered at induction of anaesthesia for facilitating muscle relaxation
|
A top-up dose of vecuronium + atracurium will be administered when the TOF count is 1 on the accelerometer.
However, if there is a diaphragmatic contraction which interferes with surgical procedure then a dose will be given irrespective of the TOF count.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Duration-of-action of the intubating dose
Time Frame: From the time of administration of (0-hours, baseline) till 60-minutes intraoperatively
|
Duration of action will be calculated from the time the drug is administered till theTOF count is 1 on the accelerometer.
|
From the time of administration of (0-hours, baseline) till 60-minutes intraoperatively
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Onset-of-action of muscle relaxation following intubating dose
Time Frame: From the time of administration of (0-hours, baseline) till 5-minutes intraoperatively
|
Onset-of-action will be calculated from the time the drug is administered till theTOF count is 0 on the accelerometer.
|
From the time of administration of (0-hours, baseline) till 5-minutes intraoperatively
|
Qualitative intubating conditions.
Time Frame: From the time of administration of (0-hours, baseline) till 5-minutes intraoperatively
|
Quality of intubating condition will be assessed using 3-point modified Cooper's scale. The intubating conditions will be graded as excellent, good & poor.
|
From the time of administration of (0-hours, baseline) till 5-minutes intraoperatively
|
Reversibility of muscle relaxant effect
Time Frame: From the time of administration of (0-hours, baseline) till 5-minutes post administration
|
Time for complete reversal of effect of muscle relaxation will be determined from the time of administration of reversal agent till the the point when TOF ratio is 90-percent.
|
From the time of administration of (0-hours, baseline) till 5-minutes post administration
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Amitabh Dutta, MD,PGDHR, Sir Ganga Ram Hospital
- Study Director: Subhash Gupta, MD, Sir Ganga Ram Hospital
- Principal Investigator: Savitar Malhotra, MD, Sir Ganga Ram Hospital
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Cholinergic Antagonists
- Cholinergic Agents
- Neuromuscular Agents
- Nicotinic Antagonists
- Neuromuscular Nondepolarizing Agents
- Neuromuscular Blocking Agents
- Atracurium
- Vecuronium Bromide
Other Study ID Numbers
- EC/10/17/1280
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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