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Low-Dose Rocuronium Maintenance During Spine Surgery With Intraoperative Neurophysiological Monitoring (ROC-IONM)

30. Mai 2026 aktualisiert von: Nguyen Toan Thang, Bach Mai Hospital

A Randomized Controlled Trial Comparing Low-Dose Rocuronium Maintenance Versus Discontinuation After Induction on Motor Evoked Potential Quality During Spine Surgery With Intraoperative Neurophysiological Monitoring

This randomized controlled trial will compare two strategies for rocuronium use during general anesthesia for spine surgery with intraoperative neurophysiological monitoring. Participants undergoing spine surgery under general anesthesia with motor evoked potential and/or somatosensory evoked potential monitoring will be randomized to either low-dose rocuronium maintenance targeting a train-of-four ratio of 0.60 to less than 0.90, or no rocuronium maintenance after induction.

The main objective is to compare the effects of these two strategies on the quality of intraoperative neurophysiological monitoring, especially motor evoked potential signals. Secondary objectives include comparing surgical field conditions, unwanted patient movement, emergence and extubation times, early respiratory events, and new postoperative neurological deficits.

The study will be conducted at the Center for Anesthesia and Surgical Intensive Care, Bach Mai Hospital, Hanoi, Vietnam. The planned sample size is 62 participants, with 31 participants in each group.

Studienübersicht

Status

Noch keine Rekrutierung

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

Intraoperative neurophysiological monitoring is commonly used during complex spine surgery to help detect early neurological injury. Motor evoked potentials are particularly sensitive to neuromuscular blockade. Avoiding maintenance neuromuscular blockade may improve motor evoked potential signal quality, but may increase the risk of unwanted patient movement and suboptimal surgical field conditions. Conversely, low-dose rocuronium maintenance may improve surgical conditions, but may reduce motor evoked potential amplitude if neuromuscular blockade is excessive.

This trial will evaluate whether low-dose rocuronium maintenance, titrated by quantitative neuromuscular monitoring, can preserve intraoperative neurophysiological monitoring quality while improving surgical field conditions compared with discontinuation of rocuronium after induction.

All participants will receive standardized total intravenous anesthesia with propofol-based maintenance, bispectral index monitoring, quantitative train-of-four monitoring, and intraoperative neurophysiological monitoring. Rocuronium will be administered for tracheal intubation in both groups. In the low-dose maintenance group, rocuronium will be titrated to maintain a train-of-four ratio from 0.60 to less than 0.90. In the no-maintenance group, no additional rocuronium will be given after induction unless predefined safety rescue is required.

The primary outcome will be intraoperative motor evoked potential signal quality, including mean motor evoked potential amplitude. Secondary outcomes will include successful motor evoked potential recording, motor evoked potential warning events, somatosensory evoked potential stability, surgical field condition, unwanted patient movement, time to emergence, time to extubation, early postoperative respiratory events, and new postoperative neurological deficits.

Studientyp

Interventionell

Einschreibung (Geschätzt)

62

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienkontakt

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

  • Erwachsene
  • Älterer Erwachsener

Akzeptiert gesunde Freiwillige

Nein

Beschreibung

Inclusion Criteria:

- 1. Patients aged 18 years or older. 2. Patients scheduled for spine surgery under general anesthesia. 3. Patients undergoing spine surgery with intraoperative neurophysiological monitoring, including motor evoked potentials and/or somatosensory evoked potentials.

4. Patients who agree to participate in the study and provide written informed consent.

Exclusion Criteria:

  • 1. Pre-existing central or peripheral neurological disease that may affect intraoperative neurophysiological monitoring, such as quadriplegia, persistent sensory disorder, sequelae of stroke, or polyneuropathy.

    2. History of epilepsy or electroencephalographic disorder. 3. Use of neuropsychiatric drugs, strong sedatives, or drugs affecting neuromuscular or neurological conduction within 48 hours before surgery.

    4. Decompensated cardiovascular disease or severe respiratory disease that may affect emergence or anesthetic drug metabolism.

    5. Contraindication to intraoperative neurophysiological monitoring. 6. Contraindication to rocuronium. 7. Refusal to participate or withdrawal of consent at any time..

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Single

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: Low-Dose Rocuronium Maintenance
Participants in this group will receive rocuronium for tracheal intubation followed by low-dose rocuronium maintenance during surgery. Rocuronium will be titrated using quantitative train-of-four monitoring to maintain a train-of-four ratio from 0.60 to less than 0.90. All participants will receive standardized total intravenous anesthesia and intraoperative neurophysiological monitoring.
Arzneimittel: Low-Dose Rocuronium Maintenance
Rocuronium will be administered for tracheal intubation and then maintained at a low dose during surgery. The infusion will be titrated according to quantitative train-of-four monitoring to maintain a train-of-four ratio from 0.60 to less than 0.90.
Aktiver Komparator: No Rocuronium Maintenance After Induction
Participants in this group will receive rocuronium for tracheal intubation only. No maintenance rocuronium will be administered after induction. Additional rocuronium may be given only as predefined safety rescue if clinically necessary. All participants will receive standardized total intravenous anesthesia and intraoperative neurophysiological monitoring.
Arzneimittel: Rocuronium
Rocuronium will be administered only for tracheal intubation during induction of anesthesia. No maintenance rocuronium will be administered after induction, except for predefined safety rescue if clinically necessary.
Andere Namen:
  • Rocuronium for Intubation Only

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Mean Intraoperative Motor Evoked Potential Amplitude
Zeitfenster: From baseline intraoperative neurophysiological monitoring after patient positioning to the final intraoperative neurophysiological monitoring recording before wound closure
Mean intraoperative motor evoked potential amplitude, measured in microvolts, recorded from predefined target muscles during spine surgery. The mean of three consecutive technically acceptable responses will be used at standardized intraoperative time points after stabilization of anesthesia and physiologic parameters.
From baseline intraoperative neurophysiological monitoring after patient positioning to the final intraoperative neurophysiological monitoring recording before wound closure

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Successful Motor Evoked Potential Recording
Zeitfenster: During surgery
Proportion of participants with successful intraoperative motor evoked potential recording from at least one predefined target muscle.
During surgery
Motor Evoked Potential Warning Events
Zeitfenster: During surgery
Number of intraoperative motor evoked potential warning events, defined as a decrease of 50 percent or more in amplitude from baseline lasting more than 5 minutes and not attributable to surgical manipulation after correction of physiologic and technical factors.
During surgery
Surgical Field Condition
Zeitfenster: During surgery
Surgical field condition assessed using the Leiden-Surgical Rating Scale, ranging from 1 to 5, with higher scores indicating better surgical conditions.
During surgery
Unwanted Patient Movement
Zeitfenster: During surgery
Occurrence and number of unwanted patient movement events that affect surgical manipulation or require anesthetic or neuromuscular blockade adjustment.
During surgery
Time to Extubation
Zeitfenster: From discontinuation of maintenance anesthesia to tracheal extubation
Time from discontinuation of maintenance anesthetic infusion to safe tracheal extubation, measured in minutes.
From discontinuation of maintenance anesthesia to tracheal extubation
New Postoperative Neurological Deficit
Zeitfenster: Post-anesthesia care unit and 24 to 48 hours after surgery
Occurrence of new postoperative motor or sensory neurological deficit assessed in the post-anesthesia care unit and within 24 to 48 hours after surgery.
Post-anesthesia care unit and 24 to 48 hours after surgery
Somatosensory Evoked Potential Stability
Zeitfenster: During surgery
Proportion of intraoperative monitoring time without significant somatosensory evoked potential changes, defined as latency increase of 10 percent or more or amplitude decrease of 50 percent or more from baseline lasting more than 5 minutes and not attributable to surgical manipulation.
During surgery
Time to Emergence
Zeitfenster: From discontinuation of maintenance anesthesia to eye opening on verbal command
Time from discontinuation of maintenance anesthetic infusion to eye opening on verbal command, measured in minutes.
From discontinuation of maintenance anesthesia to eye opening on verbal command
Early Postoperative Respiratory Events
Zeitfenster: During emergence and within 60 minutes after arrival in the post-anesthesia care unit
Occurrence of early respiratory events, including oxygen desaturation below 92 percent, laryngospasm, bronchospasm, sputum obstruction, or delayed extubation due to respiratory muscle weakness.
During emergence and within 60 minutes after arrival in the post-anesthesia care unit

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Bach Mai Hospital

Mitarbeiter

Hanoi Medical University

Ermittler

  • Hauptermittler: Toan Thang Nguyen, MD, PhD, Associate Professor, Hanoi Medical University

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Geschätzt)

1. Juni 2026

Primärer Abschluss (Geschätzt)

1. Dezember 2028

Studienabschluss (Geschätzt)

1. Dezember 2028

Studienanmeldedaten

Zuerst eingereicht

30. Mai 2026

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

30. Mai 2026

Zuerst gepostet (Tatsächlich)

4. Juni 2026

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

4. Juni 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

30. Mai 2026

Zuletzt verifiziert

1. Mai 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Schlüsselwörter

Zusätzliche relevante MeSH-Bedingungen

Andere Studien-ID-Nummern

  • HMU-BMH-ROC-IONM-2025-01
  • 225/BM-HDDD (Andere Kennung: Ethics Committee of Bach Mai Hospital)
  • 6513/QD-DHYHN (Andere Kennung: Hanoi Medical University)

Plan für individuelle Teilnehmerdaten (IPD)

Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?

NEIN

Beschreibung des IPD-Plans

Individual participant data will not be publicly shared because the study involves sensitive clinical and perioperative data. Data are protected by privacy and ethical restrictions. De-identified aggregate data may be available from the corresponding author upon reasonable request and with approval from the relevant ethics committee.

Arzneimittel- und Geräteinformationen, Studienunterlagen

Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt

Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

Produkt, das in den USA hergestellt und aus den USA exportiert wird

Nein

Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .

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