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To shorten induction time, some anesthesiologist gives a priming dose of muscle relaxant before starting Neuromuscular Transmission monitor (NMT). To properly evaluate neuromuscular function during the surgury, baseline supramaximal stimulation of the monitored nerve is mandatory. Not knowing if the priming dose of muscle relaxant affects the supramaximal stimulation current setting, The investigators designed this study to find out.
The NMT monitor module automatically determines the current needed for the supramaximal stimulus, and maintains this current throughout the procedure.
The supramaximal current is the current above which there is no increase in the evoked muscle response. At this stimulus current, all motor units are firing in response to nerve stimulation. According to previous studies, the current was significantly increased in the presence of edema and peripheral neuropathy. In this study, the route of administration, dosage, dosage regimen, and treatment period are basically the same as the investigators anesthesia department's routine procedure for general anesthesia. The difference will be the time the investigators set between the priming dose to final dose of rocuronium is 2 minutes. The investigators use 2 minutes as the peak effect of rocuronium is 105±36S.
To properly evaluate neuromuscular blockade during the surgery, baseline supramaximal stimulation of the monitored nerve is mandatory. Not knowing if the priming dose of muscle relaxant affects the supramaximal stimulation current setting, the investigators designed this study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Rocuronium priming dose 0.06mg/kg | Active Comparator | Add the priming dose of rocuronium 0.06mg/kg after the first supramaximal stimulation data measured |
|
| Rocuronium priming dose 0.12mg/kg | Active Comparator | Add the priming dose of rocuronium 0.12mg/kg after the first supramaximal stimulation data measured |
|
| Rocuronium priming dose 0.18mg/kg | Active Comparator | Add the priming dose of rocuronium 0.18mg/kg after the first supramaximal stimulation data measured |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rocuronium priming dose | Procedure | Add the priming dose of rocuronium after the first supramaximal stimulation data measured |
|
| Measure | Description | Time Frame |
|---|---|---|
| Supramaximal stimulation value | whether the supramaximal stimulation changs after 2 minutes of priming dose of muscle relaxant use | since general anesthesia induction to endotracheal tube intubation, about 10 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| supramaximal stimulation value change by time | whether the supramaximal stimulation changs have a trend | since general anesthesia induction to endotracheal tube intubation, about 10 minutes |
| dose of rocuronium |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Wei Chieh Lai, MD, MPH | Contact | +886919141289 | ndicy@yahoo.com.tw |
| Name | Affiliation | Role |
|---|---|---|
| Wei Chieh Lai, MD, MPH | Taipei Medical University Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Taipei Medical University Hospital | Recruiting | Taipei | 220 | Taiwan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 6742488 | Background | Kopman AF, Lawson D. Milliamperage requirements for supramaximal stimulation of the ulnar nerve with surface electrodes. Anesthesiology. 1984 Jul;61(1):83-5. No abstract available. | |
| 29200077 | Background | Naguib M, Brull SJ, Kopman AF, Hunter JM, Fulesdi B, Arkes HR, Elstein A, Todd MM, Johnson KB. Consensus Statement on Perioperative Use of Neuromuscular Monitoring. Anesth Analg. 2018 Jul;127(1):71-80. doi: 10.1213/ANE.0000000000002670. |
| Label | URL |
|---|---|
| Diabetes Mellitus and Neuromuscular Blockade: Review | View source |
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de-identified raw data
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whether the change of supramaximal stimulation change is muscle relaxant dose responsive
| since general anesthesia induction to endotracheal tube intubation, about 10 minutes |
| Time to intubation | how long does it take from the full dose of muslce relaxant given to TOF count <2 | since general anesthesia induction to endotracheal tube intubation, about 10 minutes |
| Intubation condition | the intubation condition with priming method used. Evaluate with scoring scale. scale range from 0-3. 0 presented as poor Jaw relaxation, closed vocal cord, and severe cough or bucking when intubation; to 3 represent a condition with good jaw relaxation, open vocal cord, and no repsponse to stimulation. | since general anesthesia induction to endotracheal tube intubation, about 10 minutes |
| 24201596 | Background | Armendariz-Buil I, Lobato-Solores F, Aguilera-Celorrio L, Morros-Diaz E, Fraile-Jimenez E, Vera-Bella J. Residual neuromuscular block in type II diabetes mellitus after rocuronium: a prospective observational study. Eur J Anaesthesiol. 2014 Aug;31(8):411-6. doi: 10.1097/01.EJA.0000435022.91954.8d. |
| 17635389 | Background | Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J; 8th International Neuromuscular Meeting. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007 Aug;51(7):789-808. doi: 10.1111/j.1399-6576.2007.01352.x. |