- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05006807
Comparison Neuromuscular Blockade Monitors
Comparative Assessment of Neuromuscular Blockade Monitors
Study Overview
Status
Conditions
Detailed Description
Twitch monitoring will be performed as described below for each device:
Stimpod NMS 450 or other related Stimpod device (Xavant Technology, Pretoria, South Africa)--acceleromyography and/or electromyography. Movement of the thumb and hand will not be restricted and no artificial preload will be used. Electrodes (3M Red Dot, 3M Healthcare, St. Paul, MN, USA) will be applied over the ulnar nerve at the wrist for acceleromyography. The Stimpod acceleromyography sensor will be attached to the distal phalanx of the thumb using the supplied plastic circumferential band, reinforced with tape if necessary. The Stimpod electromyography printed electrode array will be applied as described in the manufacturer's instructions for use.
TwitchView Monitor (Blink Device Company, Seattle, WA, USA)--electromyography. The TwitchView electromyography printed electrode array will be applied as described in the manufacturer's instructions for use.
TetraGraph (Senzime, Sweden)--electromyography. The TetraGraph electromyography printed electrode array will be applied as described in the manufacturer's instructions for use.
Nihon Kohden (Japan)--electromyography. The Nihon Kohden printed electromyography electrode array will be applied as described in the manufacturer's instructions for use.
Mechanomyography. The mechanomyography monitors were built in our laboratory and consists of a force transducer, signal amplifier and analogue to digital converter held in a 3D printed wrist and hand immobilizer, or other hand immobilizer rig. The mechanomyography force transducer response is linear with precision to 5g and accuracy to 25g for measurements examined from 0 to 5kg with sensitivity to 10g within that range. A preload of 200-300g will applied to the thumb prior to data collection. Custom software using the LabVIEW package (National Instruments, Austin, Texas) was developed for data acquisition, analysis of the voltage response after the train-of-four stimulus and for counting the twitches.
General experimental conditions. The amplitude of the train of four stimulus will be set at 60 mA in all cases. Skin prep with alcohol wipes will be performed prior to attaching any electrodes. Temperature homeostasis will be maintained in all patients through the use of active warming. Normocarbia will be maintained as defined by end tidal CO2 between approximately 32 and 40 mmHg. The anesthesia technique including the choice of anesthetic and neuromuscular blocking agents will be at the discretion of the anesthesia care team and may include propofol, opioids (mainly fentanyl and hydromorphone), sevoflurane, isoflurane, rocuronium and vecuronium. Data collection will be customized in each patient depending upon the availability of upper limbs for monitoring. Acceleromyography and mechanomyography cannot be tested on the same arm simultaneously because the mechanomyography restricts movement of the thumb. The electromyography electrode array does not interfere with simultaneously measuring either acceleromyography or mechanomyography. Subjective twitch count can be made on the same hand as the acceleromyography or electromyography measurement, but not on the same hand as mechanomyography since the plastic frame or other rig of the mechanomyography precludes manual palpation of thumb movement. Train-of- four count will be measured by palpation (when possible) and then by one or more of the twitch monitors (i.e. two measurements were taken within the span of about 2 minutes) approximately every 5 minutes from induction of anesthesia until just before emergence from anesthesia. Measurements will not be made for 10 minutes following administration of neuromuscular blocking drugs or reversal agents in order to avoid periods when the extent of neuromuscular blockade was changing very rapidly. When measurements were made on both arms, the train of four twitch stimulus will be administered in each arm within about 2 minutes. Not all twitch monitoring devices we be evaluated in each patient. The choice of devices to be evaluated in each patient will be made primarily on the basis of the availability of arms for monitoring and the availability of monitoring devices.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Lisa Flint
- Phone Number: 206 543-7817
- Email: lyflint@uw.edu
Study Locations
-
-
Washington
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Seattle, Washington, United States, 98195
- Recruiting
- University Of Washington Medical Center
-
Contact:
- Lisa Flint
- Phone Number: 206-543-7817
- Email: lyflint@uw.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- 18 years of age or greater
- Undergoing anesthesia that requires neuromuscular blocking drugs
Exclusion criteria:
- Less than 18 years of age
- Undergoing anesthesia that does not require neuromuscular blocking drugs
- Undergoing a procedure in which access to one or both arms is limited
- Anatomical abnormalities of the hands or arms that preclude twitch monitoring with ulnar nerve stimulation and evoked thumb twitch response
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Only
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Twitch Monitoring
Patients undergoing surgery with general anesthesia requiring neuromuscular blockade.
|
Measurement of train-of-four count and ratio and post tetanic count
Measurement of train-of-four count and ratio and post tetanic count
Measurement of train-of-four count and ratio and post titanic count
Measurement of train-of-four count and ratio and post tetanic count
Measurement of train-of-four count and ratio and post tetanic count
The train-of-four count is determined by manual palpation of the evoked twitch response
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Train-of-four count
Time Frame: Procedure (from the induction of anesthesia until emergence of anesthesia)
|
Counting evoked thumb twitch response to ulnar nerve stimulation
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Procedure (from the induction of anesthesia until emergence of anesthesia)
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Train-of-four ratio
Time Frame: Procedure (from the induction of anesthesia until emergence of anesthesia)
|
Ratio of the height of the 4th thumb twitch to the height of the 1st thumb twitch after ulnar nerve stimulation
|
Procedure (from the induction of anesthesia until emergence of anesthesia)
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Post tetanic count
Time Frame: Procedure (from the induction of anesthesia until emergence of anesthesia)
|
The number of twitches (0-15) following a tetanic stimulus
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Procedure (from the induction of anesthesia until emergence of anesthesia)
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Twitch count by palpation
Time Frame: Procedure (from the induction of anesthesia until emergence of anesthesia)
|
The twitch count is determined by palpation of the thumb
|
Procedure (from the induction of anesthesia until emergence of anesthesia)
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: T. Andrew Bowdle, MD, PhD, University of Washington
Publications and helpful links
General Publications
- Bowdle A, Bussey L, Michaelsen K, Jelacic S, Nair B, Togashi K, Hulvershorn J. Counting train-of-four twitch response: comparison of palpation to mechanomyography, acceleromyography, and electromyography. Br J Anaesth. 2020 Jun;124(6):712-717. doi: 10.1016/j.bja.2020.02.022. Epub 2020 Mar 28.
- Bowdle A, Bussey L, Michaelsen K, Jelacic S, Nair B, Togashi K, Hulvershorn J. A comparison of a prototype electromyograph vs. a mechanomyograph and an acceleromyograph for assessment of neuromuscular blockade. Anaesthesia. 2020 Feb;75(2):187-195. doi: 10.1111/anae.14872. Epub 2019 Oct 16.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
Other Study ID Numbers
- STUDY00001561
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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