A Pilot Study Using Rocuronium to Prevent Intermediate Syndrome After Organophosphorus Insecticide Poisoning
Status:
Completed
Trial end date:
2016-07-01
Target enrollment:
Participant gender:
Summary
Organophosphate pesticide poisoning causes close to 300 000 deaths per year worldwide. Many
patients who ingest organophosphates require ventilation; of these patients approximately 50%
die. Much of the mortality in these ventilated patients is secondary to intermediate
syndrome. This is because OP pesticides inhibit acetylcholinesterase, causing an excess of
acetylcholine at nerve synapses and the neuromuscular junction (NMJ). At the NMJ, the excess
acetylcholine causes overstimulation and damage, which may lead to sudden respiratory arrest
or prolonged ventilation and its associated complications.
The investigators believe that blocking these receptors using a neuromuscular blocking agent
such as Rocuronium will protect the NMJ from damage and thus prevent intermediate syndrome
and reduce number of intubated days and mortality.
In this pilot randomised controlled trial Rocuronium, a competitive nicotinic receptor
antagonist, will be used to bind to the receptor at the neuromuscular junction and to block
the effects of the accumulated acetylcholine. The effects of OP pesticide on cholinesterase
in the blood will then be monitored and Rocuronium withdrawn using Sugammadex as the OP is
eliminated from the body.