Reversal With Low Doses of Sugammadex in Patients Undergoing Non-cardiac Surgery
A Randomized Double Blind Trial Comparing Reversal With Low Doses Of Sugammadex aFter Rocuronium-induced Neuromuscular Block Under General Anesthesia in Patients Undergoing Non-cardiac Surgery(TOF TRIAL)
Neuromuscular blocking agents (NMBA) are among the most commonly used drugs during general anesthesia and may induce complete muscle paralysis.They are used clinically to facilitate endotracheal intubation and to optimize surgical working conditions. Incomplete recovery from non-depolarising NMBAs continues to be a common problem in modern postoperative care unit and is associated with significant risk of microaspiration and hypoventilation which leads to pulmonary complications.Recently effective reversal of neuromuscular blockade has been described by use of lower dose of sugammadex the recommended without providing adequate answer to whether the lower dose is safe enough to avoid recurrent block.
Hypotheses:
- Administration of sugammadex 0.25 mg/kg at TOF ratio 0.3 will successfully reverse (TOF=0.9) rocuronium induced neuromuscular block within 10 min.
- Recurrent block (TOF ratio < 0.9) does not occur after reversal with low dose sugammadex 0.25 mg/kg.
The primary objective of this trial is to assess the dose-response characteristics of sugammadex in reversing rocuronium induced neuromuscular block and to identify the minimal effective dose
Secondary objective is to assess the safety of different doses of sugammadex (recurrent block (TOF ratio < 0.9) after reversal and the occurrence of adverse reactions)
Sugammadex is a very expensive drug which limits its use i anaesthesia department. By optimising drug dosage it may have economic impact and contribute to a wider use of sugammadex to reverse neuromuscular block before extubation and thus avoid incomplete recovery. This may lead to less risk for postoperative pulmonary complications and thereby reduce morbidity and mortality after surgery.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Undersøgelsestype
Undersøgelsestype
Tilmelding (Forventet)
Tilmelding
Fase
Fase
- Fase 4
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Tayyba Aslam, MD
- Telefonnummer: 004798097489
- E-mail: tayybaaslam@gmail.com
Undersøgelse Kontakt Backup
- Navn: Espen Lindholm, MD, PHD
- Telefonnummer: 004792213346
- E-mail: espen.lindholm@siv.no
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Patient, both genders, undergoing any elective in-hospital surgical procedure under general anesthesia requiring rocuronium neuromuscular block.
- ASA I-IV
- Signed informed consent
Exclusion Criteria:
- Patient less than 18 years of age
- Patient participating in another clinical study which could interfere with TOF trial.
- Patient with neuromuscular disease
- Patient from ICU
- BMI > 30.0 kg/m2
- Patient scheduled for local or regional anesthesia only
- Patient undergoing general anesthesia without rocuronium
- Patient with hypersensitivity to NMBAs or sugammadex. Also hypersensitivity to any active substance or to any of the following excipient: Hydrochloric acid 3.7% (to adjust pH) and/or sodium hydroxide (to adjust pH) Water for injections .
- Renal dysfunction (GFR<30 mL/min/1,73m2)
- Hepatic dysfunction
- Patient who have received sugammadex in the last 24 h.
- Pregnant or breastfeeding woman. Women in childbearing age must have a negative pregnant test before inclusion.
- Bradycardia (puls <40)
- Hypotension (Systolic BP <90 mmHg)
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Firedobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Placebo komparator: Sugammadex 0 mg/kg
Placebo NaCl 0,9%
|
Dose-response
|
|
Aktiv komparator: Sugammadex 0,25 mg/kg
Sugammadex 0.25 mg/kg IBW
|
Dose-response
|
|
Aktiv komparator: Sugammadex 0,5 mg/kg
Sugammadex 0.50 mg/kg IBW
|
Dose-response
|
|
Aktiv komparator: Sugammadex 1mg/kg
Sugammadex 1.0 mg/kg IBW
|
Dose-response
|
|
Aktiv komparator: Sugammadex 2mg/kg
Sugammadex 2 mg/kg IBW
|
Dose-response
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
The time from study drug administration to reaching a TOF ratio of 0.9.
Tidsramme: 10 minutes
|
10 minutes
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Number of patient with reoccurrence of neuromuscular block after initial reversal to TOF ratio 0.9.
Tidsramme: 20 minutes
|
20 minutes
|
|
|
Number of patients with adverse reactions in each group
Tidsramme: until discharge - 3 days
|
Adverse reactions (anaphylactic reaction, flushing, urticaria, erythematous rash, (severe) hypotension (BPsyst> 75 mmHg), tachycardia (heart rate> 120 beats/min), bradycardia (heart rate <40 beats/min), swelling of tongue, swelling of pharynx, bronchospasm)
|
until discharge - 3 days
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Forventet)
Studiestart
Primær færdiggørelse (Forventet)
Primær færdiggørelse
Studieafslutning (Forventet)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- SIVAA01
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