Strategy for Maintaining Partial Neuromuscular Blocking Adequate for Motor Evoked Potential During Neurosurgery

Samsung Medical Center

Status: Completed

Conditions: Spine Surgery With Motor Evoked Potential Monitoring; Brain Surgery With Motor Evoked Potential Monitoring

Treatments: Other: T2/ T0 guided adjustment; Other: T1/ T0 guided adjustment; Other: TOF count guided adjustment

Study type: Interventional

Funder types: Other

Identifiers

NCT01388868

2011-04-010

Details and patient eligibility

About

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).

Full description

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.

Enrollment: 90 patients

Sex: All

Ages: 20 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult Patients undergoing neurosurgery with intraoperative motor evoked potential monitoring

Exclusion criteria

• Patients who can not undergo motor evoked potential monitoring due to central or peripheral neuromuscular disease (e.g. Cerebral palsy, Myasthenia gravis, Acute spinal injury, neurologic shock)
• Patients with hepatic or renal disease with altered metabolism of vecuronium
• Patients with medication which influence the metabolism of vecuronium (e.g. calcium channel blocker, aminoglycoside antibiotics, Lithium, MgSO4)

Trial design

90 participants in 3 patient groups

TOF count guided group

Active Comparator group

Description:

adjustment of neuromuscular blocking agent infusion dose every 15 minute as guided by No. of response to TOF stimulation

Treatment:

Other: TOF count guided adjustment

T1/T0 guided group

Experimental group

Description:

adjustment of neuromuscular blocking agent infusion dose every 15 minute as guided by T1 twitch height as compared with control (T0)

Treatment:

Other: T1/ T0 guided adjustment

T2/ T0 guided group

Experimental group

Description:

adjustment of neuromuscular blocking agent infusion dose every 15 minute as guided by T2 twitch height as compared with baseline (T0)

Treatment:

Other: T2/ T0 guided adjustment