Determination of Target of Adequate Partial Neuromuscular Blockade for Electrophysiologic Monitoring During Microvascular Decompression Surgery - Full Text View

Purpose

There have been reports of monitoring LSR during MVD surgery helps predicting the clinical outcome of MVD. However, there have been no evidence of which degree of partial neuromuscular blockade should be performed during LSR monitoring under sevoflurane anesthesia. Therefore, the investigators performed a randomized controlled trial to evaluate the effect of different degree of partial neuromuscular blockade on the LSR monitoring for MVD surgery.

Condition	Intervention
Hemifacial Spasm Microvascular Decompression Neuromuscular Blockade	Other: TOF count-guided partial NMB Other: T1/Tc guided partial NMB

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Outcomes Assessor)
Official Title:	Determination of Target of Adequate Partial Neuromuscular Blockade With Sevoflurane Anesthesia for Electrophysiologic Monitoring During Microvascular Decompression Surgery

Further study details as provided by Samsung Medical Center:

Primary Outcome Measures:

Lateral spread response [ Time Frame: baseline (30 min after anesthetic induction) ] [ Designated as safety issue: No ]
Lateral spread response of electromyography measured by electrophysiologist at baseline (30 min after anesthetic induction)
Lateral spread response [ Time Frame: before dura opening (45 minute after anesthetic induction) ] [ Designated as safety issue: No ]
Lateral spread response of electromyography measured by electrophysiologist before dura opening
Lateral spread response [ Time Frame: after dura opening (60 min after anesthetic induction) ] [ Designated as safety issue: No ]
Lateral spread response of electromyography measured by electrophysiologist after dura opening (one hour after anesthetic induction)
Lateral spread response [ Time Frame: before facial nerve decompression (90 minutes after anesthetic induction) ] [ Designated as safety issue: No ]
Lateral spread response of electromyography measured by electrophysiologist before facial nerve decompression (90 minutes after anesthetic induction)
Lateral spread response [ Time Frame: after facial nerve decompression (120 min after anesthetic induction) ] [ Designated as safety issue: No ]
Lateral spread response of electromyography measured by electrophysiologist after facial nerve decompression (2 hour after anesthetic induction)
Lateral spread response [ Time Frame: after dura closure (150 min after anesthetic induction) ] [ Designated as safety issue: No ]
Lateral spread response of electromyography measured by electrophysiologist after dura closure (150 min after anesthetic induction)

Secondary Outcome Measures:

Train-of-four response [ Time Frame: Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction) ] [ Designated as safety issue: No ]
Train-of-four response to ulnar nerve electrical stimulation measured by NMT module at six time-points; Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction)
T1/Tc amplitude [ Time Frame: Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction) ] [ Designated as safety issue: No ]
T1/Tc amplitude as a reponse to ulnar nerve stimulation measured by NMT module at six time points; Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction)
incidence of patients' spontaneous movements or respiration [ Time Frame: Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction) ] [ Designated as safety issue: No ]
incidence of patients' spontaneous movements or respiration measured by anesthesiologists or reported by surgeon at six time points; Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction)
Mean blood pressure (mmHg) [ Time Frame: Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction) ] [ Designated as safety issue: No ]
mean blood pressure measured by anesthesiologists at six time points; Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction)
heart rate (beats/min) [ Time Frame: Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction) ] [ Designated as safety issue: No ]
heart rate measured by anesthesiologists at six time points; Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction)
pulse oximetry (oxygen saturation, %) [ Time Frame: Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction) ] [ Designated as safety issue: No ]
pulse oximetry measured by anesthesiologists at six time points; Baseline (30min), Before dura open (45 min), After dura open (60 min), Before decompression (90 min), After decompression (120 min), After dura close (150 min after anesthetic induction)

Estimated Enrollment:	60
Study Start Date:	June 2012
Estimated Study Completion Date:	December 2012
Estimated Primary Completion Date:	December 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: T1/Tc amplitude-guided group Using partial neuromuscular blockade to maintain T1/Tc amplitude of 50%, T1/Tc amplitude measured by the neuromuscular transmission module (NMT)	Other: T1/Tc guided partial NMB Using partial neuromuscular blockade to maintain T1/Tc amplitude of 50%, T1/Tc amplitude measured by the neuromuscular transmission module (NMT) Other Name: neuromuscular transmission module (NMT)
Active Comparator: TOF count-guided group Using partial neuromuscular blockade to maintain train-of-four response of two, TOF response measured by the neuromuscular transmission module (NMT module)	Other: TOF count-guided partial NMB TOF count-guided partial NMB Using partial neuromuscular blockade to maintain train-of-four response of two, TOF response measured by the neuromuscular transmission module (NMT module) Other Name: neuromuscular transmission module (NMT module)

Detailed Description:

Hemifacial spasm develops by vascular compression of facial nerve at the root exit zone from brain stem. Microvascular decompression (MVD) is known for its curative treatment. Lateral spread response (LSR) is a kind of pathologic electromyographic (EMG) wave form which develops when facial nerve is compressed by vessel. There have been reports of monitoring LSR during MVD surgery helps predicting the clinical outcome of MVD.

As neuromuscular blockade during LSR monitoring decreases the amplitude of EMG, partial neuromuscular blockade is usually maintained during general anesthesia for MVD. However, there have been no evidence of which degree of partial neuromuscular blockade should be performed during LSR monitoring under sevoflurane anesthesia. Therefore, the investigators performed a randomized controlled trial to evaluate the effect of different degree of partial neuromuscular blockade on the LSR monitoring for MVD surgery.

Eligibility

Ages Eligible for Study:	20 Years to 70 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Those who undergo microvascular decompression with sevoflurane anesthesia by diagnosis of hemifacial spasm in our institution

Exclusion Criteria:

Patients were excluded from the study if they had any of following: severe cardiopulmonary disorder with hemodynamic unstability (pulmonary hypertension, cardiomyopathy, mechanical ventilation, American Society of Anesthesiologists physical status III or more), severe hepatic or renal disease.
Those who can not undergo MEP monitoring due to central or peripheral neuromuscular disease, e.g. cerebral palsy, myasthenia gravis, acute spinal injury, neurologic shock

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01613781

Contacts

Contact: Jeong Jin Lee, MD, PhD	82-2-3410-2467	jjeong.lee@samsung.com
Contact: Yang Hoon Chung, MD	82-2-3410-1994	yh79.chung@samsung.com

Locations

Korea, Republic of
Samsung Medical Center	Recruiting
Seoul, Korea, Republic of, 135-710
Contact: Won Ho Kim, MD 82-2-3410-1994 bullet57@naver.com
Contact: Yang Hoon Chung, MD 82-2-3410-1994 yh79.chung@samsung.com
Principal Investigator: Jeong Jin Lee, MD, PhD
Principal Investigator: Won Ho Kim, MD

Sponsors and Collaborators

Samsung Medical Center

Investigators

Principal Investigator:	Jeong Jin Lee, MD, PhD	Samsung Medical Center
Principal Investigator:	Won Ho Kim, MD	Samsung Medical Center

More Information

No publications provided

Responsible Party:	Jeong Jin Lee, Professor, Samsung Medical Center
ClinicalTrials.gov Identifier:	NCT01613781 History of Changes
Other Study ID Numbers:	2012-05-051
Study First Received:	June 5, 2012
Last Updated:	June 19, 2012
Health Authority:	South Korea: Institutional Review Board

Keywords provided by Samsung Medical Center:

hemifacial spasm
microvascular decompression
neuromuscular blockade
electromyography

Additional relevant MeSH terms:

Spasm
Hemifacial Spasm
Neuromuscular Manifestations
Neurologic Manifestations

Nervous System Diseases
Signs and Symptoms
Mouth Diseases
Stomatognathic Diseases

ClinicalTrials.gov processed this record on May 23, 2013