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Chemotherapy causes motor nerve dysfunction and degeneration that may alter the response to neuromuscular blocking drugs. To analyse the risk of residual neuromuscular block (RNMB) induced by rocuronium given in standard doses to patients who undergo chemotherapy within three months.
Rocuronium, as a non depolarizing muscle relaxant with medium time effect, takes effect rapidly. It is an ideal neuromuscular blocker to replace succinylcholine for induction of tracheal intubation and maintenance of muscle relaxant under general anesthesia. Sevoflurane is widely used in clinic because of its low blood gas partition coefficient, rapid and stable induction and recovery, easy adjustment of anesthesia depth and strong controllability. In addition, the number of patients receiving preoperative adjuvant chemotherapy for malignant tumors is increasing year by year in China. The commonly used chemotherapy drugs, such as paclitaxel, platinum, vinorelbine, etc., have dose-dependent peripheral neurotoxicity. Therefore, to explore and study the influence of pathophysiological changes of patients receiving chemotherapy on the neuromuscular relaxation effect of sevoflurane combined with non depolarizing neuromuscular blockers, It is very important for anesthesia, resuscitation and perioperative management of chemotherapy patients. The purpose of this study is to reveal the effect of sevoflurane on rocuronium neuromuscular blockade in chemotherapy patients by comparing the difference of rocuronium neuromuscular blockade effect of sevoflurane and total intravenous anesthesia in chemotherapy patients and non chemotherapy patients, and to provide information for more safe and rational application of rocuronium in clinical anesthesia of chemotherapy patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| chemotherapy patients using sevoflurane anesthesia | Experimental | Following induction of anesthesia and laryngeal mask placement, anesthesia will be maintained by inhalation of sevoflurane (approximately 1.3 × minimum alveolar concentration) and IV fentanyl according to clinical need. |
|
| chemotherapy patients using total intravenous anesthesia | Active Comparator | Following induction of anesthesia and laryngeal mask placement, maintenance of anesthesia will consist of target-controlled infusion of propofol at a plasma target concentration of 1.5-3.0µg/ml and IV fentanyl according to clinical need. |
|
| nonchemotherapy patients using sevoflurane anesthesia | Active Comparator | Following induction of anesthesia and laryngeal mask placement, anesthesia will be maintained by inhalation of sevoflurane (approximately 1.3 × minimum alveolar concentration) and IV fentanyl according to clinical need. |
|
| nonchemotherapy patient using total intravenous anesthesia | Active Comparator | Following induction of anesthesia and laryngeal mask placement, maintenance of anesthesia will consist of target-controlled infusion of propofol at a plasma target concentration of 1.5-3.0µg/ml and IV fentanyl according to clinical need. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| sevoflurane anesthesia | Drug | Sevoflurane enhances the effects of rocuronium and significantly prolongs the duration of action of rocuronium and the time to recovery. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Muscle relaxation recovery index | Time interval from 25% recovery to 75% recovery of the first twitch in the TOF stimulation pattern | The first 90 min following intravenous injection of rocuronium |
| Measure | Description | Time Frame |
|---|---|---|
| Onset time of muscle relaxation | Time interval from the completion of intravenous injection of rocuronium to the maximal depression of the first twitch in the TOF stimulation pattern | The first 90 min following intravenous injection of rocuronium |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical duration of muscle relaxation | Time interval from the completion of intravenous injection of rocuronium to 25% recovery of the first twitch in the TOF stimulation pattern | The first 90min following intravenous injection of rocuronium |
| TOF ratio |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lili Fang, Dr. | Contact | +8615068892166 | fanglili@zju.edu.cn |
| Name | Affiliation | Role |
|---|---|---|
| Lili Fang, Dr. | Second Affiliated Hospital Zhejiang University School of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Huzhou Central Hospital | Huzhou | Zhejiang | 313000 | China |
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| ID | Term |
|---|---|
| D000769 | Anesthesia, Inhalation |
| D015742 | Propofol |
| D000771 | Anesthesia, Intravenous |
| ID | Term |
|---|---|
| D000768 | Anesthesia, General |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D010636 | Phenols |
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Eighty patients undergoing liver radiofrequency ablation surgery under elective general anesthesia were selected, of whom 40 received preoperative adjuvant chemotherapy and the other 40 were nonchemotherapy patients, who were divided by randomization according to the method of anesthesia maintenance, respectively.Chemotherapy patients were divided into PC group with 20 cases using all intravenous anesthesia and SC group with 20 cases using sevoflurane anesthesia.The nonchemotherapy patients were divided into PN group with 20 cases using all intravenous anesthesia and Sn group with 20 cases using sevoflurane anesthesia.
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|
| Propofol Injection | Drug | Propofol is most commonly used for intravenous anesthesia. In contrast to sevoflurane, propofol has no effects on rocuronium. |
|
|
Dividing the amplitude of the fourth response by the amplitude of the first response
| 10min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 10min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 20min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 20min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 30min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 30min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 40min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 40min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 50min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 50min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 60min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 60min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 70min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 70min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 80min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 80min following intravenous injection of rocuronium |
| TOF ratio | Dividing the amplitude of the fourth response by the amplitude of the first response | 90min following intravenous injection of rocuronium |
| T1 amplitude | The amplitude of the first twitch to TOF stimulation | 90min following intravenous injection of rocuronium |
| Quzhou People's Hospital | Quzhou | Zhejiang | 324002 | China |
|
| D001555 |
| Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |