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The maintenance of partial neuromuscular blocking during general anesthesia for neurosurgery is essential for intraoperative motor-evoked potential monitoring. However, the precise strategy of administering neuromuscular blocking agent for obtaining that goal has not been established. Therefore, the investigators tried to find the optimal initial dose of vecuronium infusion and determine the adequate goal of neuromuscular blocking as guided by neuromuscular transmission module (M-NMT Module, Datex-Ohmeda Inc, Helsinki, Finland).
The maintenance of partial neuromuscular blocking during general anesthesia for neurosurgery is essential for intraoperative motor-evoked potential monitoring. However, the precise strategy of administering neuromuscular blocking agent for obtaining that goal has not been established. Therefore, the investigators tried to find the optimal initial dose of vecuronium infusion and determine the adequate goal of neuromuscular blocking as guided by neuromuscular transmission module (M-NMT Module, Datex-Ohmeda Inc, Helsinki, Finland). Previously, one to two counts of response to TOF stimulation has been considered to be primary goal of partial neuromuscular blocking needed for intraoperative motor evoked potential monitoring. However, the visualization of twitch height of response to TOF stimulation has been possible with the help of NMT module. For adequate motor evoked potential monitoring, twitch height of T1 or T2 is also as important as simple count of TOF stimulation. The investigators tried to establish a vecuronium infusion strategy as guided by not only count of TOF stimulation but also twitch height of T1 or T2.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TOF count guided group | Active Comparator | adjustment of neuromuscular blocking agent infusion dose every 15 minute as guided by No. of response to TOF stimulation |
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| T1/T0 guided group | Experimental | adjustment of neuromuscular blocking agent infusion dose every 15 minute as guided by T1 twitch height as compared with control (T0) |
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| T2/ T0 guided group | Experimental | adjustment of neuromuscular blocking agent infusion dose every 15 minute as guided by T2 twitch height as compared with baseline (T0) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TOF count guided adjustment | Other | adjustment of vecuronium infusion dose every 15 minutes as guided by No. of response to TOF stimulation displayed by NMT module. |
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| Measure | Description | Time Frame |
|---|---|---|
| Amplitude of MEP monitoring | the value of MEP amplitude every 30 min during MEP monitoring | every 30 min during MEP monitoring |
| Measure | Description | Time Frame |
|---|---|---|
| latency of MEP monitoring | latency of MEP monitoring every 30 min during MEP monitoring | every 30 min during MEP monitoring |
| Incidence of patient's spontaneous movement | Incidence of patient's spontaneous movement during MEP monitoring |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jeong Jin Lee, M.D.,Ph.D. | Samsung Medical Center | Principal Investigator |
| Won Ho Kim, M.D. | Samsung Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jeong Jin Lee | Seoul | 135-710 | South Korea |
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| T1/ T0 guided adjustment | Other | adjustment of vecuronium infusion dose every 15 minutes as guided by T1 twitch height as compared with baseline (T0) displayed by NMT module. |
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| T2/ T0 guided adjustment | Other | adjustment of vecuronium infusion dose every 15 minutes as guided by T2 twitch height as compared with baseline (T0)displayed by NMT module. |
|
| from start to end of the MEP monitoring, an expected average of 4 hours |
| Overall assessment of MEP monitoring quality | overall assessment of MEP monitoing quality provided by the electrophysiologist Grade I : no problem all through the monitoring Grade II : difficulty of monitoring for less than 5 min Grade III : difficulty of monitoring for 5 min to 30 min Grade IV : Difficulty of monitoring for more than 30 min | from start to end of the MEP monitoring, an expected average of 4 hours |
| Incidence of patient's spontaneous respiration | Incidence of patient's spontaneous respiration as determined by end-tidal CO2 curve monitoring | from start to end of the MEP monitoring, an expected average of 4 hours |