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The Effect of Neostigmine and Sugammadex on the Optic Nerve Sheath Diameter

19. juni 2026 oppdatert av: Ersel GULEC, Cukurova University

Comparison of the Effects of Neostigmine and Sugammadex on the Optic Nerve Sheath Diameter During the Postoperative Extubation Period

This study will compare how two drugs, sugammadex and neostigmine-used to reverse muscle relaxation after surgery-affect the size of the optic nerve sheath (the nerve behind the eye) as patients wake up and have their breathing tubes removed. It will also examine the relationship between changes in blood pressure and heart rate during this time and these measurements. This study will be conducted on 86 healthy patients aged 18-65 who will undergo planned surgery at the Çukurova University Faculty of Medicine, Department of Anesthesiology and Reanimation. Patients will be randomly divided into two groups: the sugammadex group and the neostigmine group. All patients will receive standard general anesthesia and rocuronium to relax their muscles. At the end of the surgery, to reverse this effect, patients will be given either sugammadex or a mix of neostigmine and atropine. Group S will receive 2 mg sugammadex per kg, while Group N will receive 0.05 mg neostigmine and 0.02 mg atropine per kg. The width of the optic nerve sheath will be measured by ultrasound 5 minutes after the breathing tube is inserted, 5 minutes before the tube is removed, and 5 minutes after it is removed. Additionally, blood pressure, heart rate, and any complications during the surgery will be tracked and compared between the groups.

Studieoversikt

Status

Rekruttering

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

The study will be conducted prospectively, randomly, and double-blind on a total of 86 patients aged 18-65 years, classified as ASA 1-2, undergoing elective surgery at the Department of Anesthesiology and Reanimation, Faculty of Medicine, Çukurova University. Written and verbal informed consent will be obtained from all participants prior to the study.

The demographic data, such as age, gender, body weight, and height, as well as ASA score and information on comorbidities, will be recorded for the patients included in the study in the preoperative anesthesia care unit. All patients who will be taken to the operating room without premedication will undergo routine monitoring, including electrocardiography, noninvasive blood pressure monitoring, and peripheral oxygen saturation. During induction of anesthesia, propofol IV 2 mg/kg, rocuronium IV 0.6 mg/kg, and fentanyl IV 1 mcg/kg will be used. After observing adequate muscle relaxation with a TOF (Train-of-Four) monitor, tracheal intubation will be performed. All patients will receive mechanical ventilation after intubation. During anesthesia, a gas mixture of 2% sevoflurane, 60% nitrous oxide, and 40% oxygen will be administered at a flow rate of 2 L/min. To maintain muscle relaxation throughout the surgery, when a TOF of 2 is observed, 0.2 mg/kg of rocuronium IV will be administered. Tramadol 2 mg/kg IV will be given 45 minutes before the end of surgery for postoperative pain management. Ondansetron 8 mg IV will be planned as antiemetic treatment. At the end of the surgery, the maintenance gases will be discontinued, and according to the randomization, the anesthesiologist responsible for anesthesia administration will either administer 2 mg/kg Sugammadex IV or 0.05 mg/kg Neostigmine IV plus 0.02 mg/kg atropine sulfate IV. Patients who show a TOF value of 90% and clinically adequate respiration will be extubated.

In addition to the anesthesiologist responsible for administering anesthesia, one blinded evaluator for each group will perform three ultrasound measurements on both eyes to determine the Optic nerve sheath diameter at 5 minutes after endotracheal intubation, 5 minutes before extubation, and 5 minutes after extubation. The measurements will be recorded while the patient is in a supine position, with ultrasound gel applied to the eyelid, using a linear probe without applying pressure to the eyeball.

The diameter of the optic nerve sheath will be systematically measured at a point 3.0 mm posterior to the optic disc to ensure consistent anatomical evaluation.

Studietype

Intervensjonell

Registrering (Antatt)

86

Fase

  • Fase 4

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Studiesteder

  • Tyrkia (Türkiye)
      • Adana, Tyrkia (Türkiye)
        • Rekruttering
        • Cukurova University Faculty of Medicine
        • Hovedetterforsker:
          • Ersel Gulec, MD
        • Underetterforsker:
          • Mediha Turktan, MD
        • Underetterforsker:
          • Zehra Hatipoglu, MD
        • Underetterforsker:
          • Dilek Ozcengiz, MD
        • Ta kontakt med:
        • Underetterforsker:
          • Kubra Gunsur, MD
        • Underetterforsker:
          • Demet Lafli Tunay, MD

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Voksen
  • Eldre voksen

Tar imot friske frivillige

Nei

Beskrivelse

Inclusion Criteria:

  • With an ASA physical status of 1-2
  • Patients scheduled for elective surgery
  • Patients willing to participate in the study

Exclusion Criteria:

  • Patients with heart, liver, kidney, or respiratory failure
  • Brain tumors, hemorrhages, or aneurysms
  • Patients who have undergone eye, cardiovascular, or neurosurgery
  • Eye or neurological diseases or increased intracranial pressure
  • Laparoscopic surgeries
  • Cases not in the supine position
  • Allergy to the medications used
  • Patients who did not provide informed consent to participate in the study.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Dobbelt

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Aktiv komparator: Group S
Sugammadex, intravenous, 2 mg/kg, single bolus dose.
Legemiddel: Sugammadex 2 mg/kg
Intravenous bolus injection
Aktiv komparator: Group N
Neostigmine, intravenous, 0.05 mg/kg, single bolus dose. Atropine sulfate, intravenous, 0.02 mg/kg, single bolus dose.
Legemiddel: Neostigmine + Atropine
Intravenous bolus injection

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Change in average optic nerve sheath diameter from intubation to the 5th minute after extubation
Tidsramme: From the time of endotracheal intubation until 5 minutes after extubation
Three measurements will be taken for each eye using ultrasound to determine the diameter of the optic nerve sheath at 5 minutes after endotracheal intubation, 5 minutes before extubation, and 5 minutes after extubation; the average values for each eye will be recorded. Subsequently, the averages of the measurements obtained for both eyes will be calculated. Changes in these averages over time will be compared between groups.
From the time of endotracheal intubation until 5 minutes after extubation

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Blood Pressure
Tidsramme: From the time of endotracheal intubation until 5 minutes after extubation
Blood pressure will be measured and recorded 5 minutes after endotracheal intubation, 5 minutes before extubation, and 5 minutes after extubation
From the time of endotracheal intubation until 5 minutes after extubation
Postoperative nausea and vomiting
Tidsramme: The one-hour period from endotracheal tube removal to patient discharge from the postoperative care unit.
The number of patients who experienced nausea and vomiting upon waking from anesthesia and during their stay in the postoperative care unit.
The one-hour period from endotracheal tube removal to patient discharge from the postoperative care unit.
Blood pressure
Tidsramme: The one-hour period from endotracheal tube removal to patient discharge from the postoperative care unit.
Noninvasive measurement of blood pressure
The one-hour period from endotracheal tube removal to patient discharge from the postoperative care unit.

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Cukurova University

Etterforskere

  • Hovedetterforsker: Ersel Gulec, MD, Cukurova University

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

4. juni 2026

Primær fullføring (Antatt)

10. juli 2026

Studiet fullført (Antatt)

10. juli 2026

Datoer for studieregistrering

Først innsendt

8. juni 2026

Først innsendt som oppfylte QC-kriteriene

19. juni 2026

Først lagt ut (Faktiske)

24. juni 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

24. juni 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

19. juni 2026

Sist bekreftet

1. juni 2026

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 25-AKD-309

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

JA

IPD-planbeskrivelse

All collected IPD may be shared with relevant parties upon request, with the principal investigator's approval, provided that no personally identifiable information or hospital records are disclosed.

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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