Best Management of Muscle Relaxation- Objective Monitoring

• Status: Recruiting
• Trial end date: 2019-12-01
• Target enrollment: 200
• Participant gender: All

Summary

The purpose of this study is to demonstrate that the investigators can reduce residual paralysis to a very low incidence, and that the investigators can do this while preserving a role for the older and less expensive reversal agent neostigmine. The investigators consider this an evidence-based approach because previous reports clearly indicate that neostigmine is effective for reversal of the most shallow neuromuscular blocks, a level of block now referred to as minimal block. The Investigators also know from previous data that a substantial proportion of patients have minimal block. Sugammadex will be used when the block to be reversed is deeper than minimal, specifically when the objectively measured TOF-ratio is <40%.

The investigators hypothesize that this protocol will be associated with an incidence of residual paralysis of less than 3%. The investigators plan is to study 200 patients.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Washington
• Treatments: Neostigmine; Rocuronium

Criteria

Inclusion Criteria:

• Are 18 years or older

• Undergoing surgery expected to last less than 6 hours at HMC or UWMC

• Have ASA physical status I-III

• Scheduled to have general anesthesia with at least 1 dose of nondepolarizing NMBD for endotracheal intubation or intraoperative neuromuscular block (NMB)

Exclusion Criteria:

• Allergy to NMBDs, neostigmine, or sugammadex

• Patients with neuromuscular disease (myasthenia gravis or muscular dystrophy)

• Pregnant or lactating women

• Non English speaking

• Unable to provide informed consent

• Severe renal failure with eGFR less than 20 ml/min