Relation Between TOF-Watch® SX and a Peripheral Nerve Stimulator After 4.0 mg.Kg-1 Sugammadex (P05698)

Merck Sharp & Dohme (MSD)

Status and phase: Completed; Phase 3

Conditions: Neuromuscular Blockade

Treatments: Drug: sugammadex

Study type: Interventional

Funder types: Industry

Identifiers

NCT00535496

P05698

19.4.313

Details and patient eligibility

About

The objective of the trial is to determine the relationship within a participant between the time to manual detection of the reappearance of the fourth twitch (T4) measured using a peripheral nerve stimulator (PNS) and the time to recovery of the fourth twitch/first twitch (T4/T1) ratio to 0.9 measured using a Train Of Four (TOF)-Watch® SX, of 4.0 mg/kg sugammadex administered at 15 minutes after either a bolus dose of 0.6 mg/kg rocuronium or the last maintenance dose of 0.15 mg/kg rocuronium.

Full description

The TOF-Watch® SX has been used for neuromuscular monitoring in all

clinical trials with sugammadex. In clinical practice however, a PNS is commonly

used in many hospitals worldwide. A disadvantage of a PNS is that it is not objective monitoring like the TOF-Watch® SX, and it can detect only the number of twitches. In this trial, the relationship between the time to reappearance of T4 using PNS (i.e. Ministim® model MS-IV) and the time to recovery of the T4/T1 ratio to 0.9 using the TOF-Watch® SX was determined after a dose of 4.0 mg/kg sugammadex was administered 15 minutes after the last dose of rocuronium. Determining this relationship will enable the provision of advice on when it is safe to extubate participants after administration of 4.0 mg/kg sugammadex for reversing neuromuscular block while using a PNS. The time to reappearance of T4 was assessed by a blinded PNS-assessor. This assessor was blinded for the dose of sugammadex used and for the TOF results measured with the TOF-Watch® SX.

Enrollment: 91 patients

Sex: All

Ages: 18 to 64 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologists (ASA) Class 1 or 2 or 3
• between the ages of 18 to 64 years, inclusive
• scheduled for a surgical procedure under general anesthesia requiring

neuromuscular relaxation with the use of rocuronium

• scheduled for a surgical procedure in supine position
• have given written informed consent

Exclusion criteria

• participants with a difficult intubation because of expected anatomical

malformations

• known or suspected to have neuromuscular disorders impairing

neuromuscular blockade and/or significant hepatic and/or renal

dysfunction

• medical or physical condition that is expected to interfere

with the proper conduct of simultaneous neuromuscular monitoring on

both arms

• known or suspected to have a (family) history of malignant

hyperthermia

• known or suspected to have arthritis or another disease that will

cause the thumb not to move freely

• known or suspected to have an allergy to narcotics, muscle

relaxants or other medication used during general anesthesia

• is receiving medication in a dose and/or at a time point known to

interfere with neuromuscular blocking agents (NMBAs), such as antibiotics, anticonvulsants and Mg2+

• already participated in a sugammadex trial
• participated in another clinical trial, not pre-approved, within prior 30 days
• pregnant females
• breast-feeding females

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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91 participants in 4 patient groups

1

Experimental group

Description:

sugammadex 1.0 mg/kg, TOF-Watch® SX (dominant forearm) and PNS (non-dominant forearm)

Treatment:

Drug: sugammadex

2

Experimental group

Description:

sugammadex 1.0 mg/kg, TOF-Watch® SX (non-dominant forearm) and PNS (dominant forearm)

Treatment:

Drug: sugammadex

3

Experimental group

Description:

sugammadex 4.0 mg/kg, TOF-Watch® SX (dominant forearm) and PNS (non-dominant forearm)

Treatment:

Drug: sugammadex

4

Experimental group

Description:

sugammadex 4.0 mg/kg, TOF-Watch® SX (non-dominant forearm) and PNS (dominant forearm)

Treatment:

Drug: sugammadex