Compare the Operating Condition of Two Levels of Muscle Relaxation on Facial Nerve MEP Monitoring in CPA Surgery

Study Overview
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Brief Summary
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compare the operating condition of two different levels of muscle relaxation on facial nerve monitoring using transcranial motor evocked potential in CPA surgery . To Estimate End to start facial nerve MEP amplitude ratio To determine the effect of neuromuscular relaxant degrees on recovery and Assessment of propofol doses needed for enhancement of early recovery and ambulation.

Detailed Description
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40 Patients aged from 18-60 years old undergoing Cerebellopontine angle surgery. Patients will be one of two groups: Both Induction will be accomplished with fentanyl, propofol , rocronium infusion will be given randomly to one of the groups. Depth of anaesthesia, neurotransmitter monitoring and facial nerve neurophysiological monitoring will be done.

Official Title
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Intraoperative Monitoring of Facial Nerve in Patients Undergoing Cerbellopontine Angle Tumer Resection Using Partial Versus no Neuromuscular Block

Conditions
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Cerebellopontine Angle Tumor

Intervention / Treatment
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* Drug: Rocroniom, Non Depolarizing Muscle Relaxant


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients age between >18 and<60. Patients scheduled for neurosurgical CPA surgeries Ability to sign the consent ASA classification I, II Exclusion Criteria: ASA > II Hemodynamically unstable Disease affecting neuromuscular transmission (myasthenia gravies ...etc.) GCS < 15. Any cardiac patient (ischemic heart disease - cardiomyopathy...etc.)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: muscle relaxant<br>patient who will receive muscle relaxant, patients will receive rocronium infusion by (5 mcg/kg/min) , maintain partial NMB TOF count 2 and targeting BIS = (40-60) | Drug: Rocroniom, Non Depolarizing Muscle Relaxant<br>* compare the operating condition of two different levels of muscle relaxation on facial nerve monitoring using transcranial motor evocked potential in CPA surgery<br>* Other names: BIS bispectral index;|
| Placebo Comparator: without muscle relaxant<br>patient who will not receive muscle relaxant, will recieve normal saline targeting BIS = 40-60. | Drug: Rocroniom, Non Depolarizing Muscle Relaxant<br>* compare the operating condition of two different levels of muscle relaxation on facial nerve monitoring using transcranial motor evocked potential in CPA surgery<br>* Other names: BIS bispectral index;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| End to start facial nerve MEP amplitude ratio. | TCMEP recording will begin (1) prior to skin incision as baseline amplitude before muscle relaxant be taken for intubation (2) at Dural closure and end \start amplitude ratio will be calculated. | 6 to 8 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of hypotension episodes and the use of vasopressors | hemodynamic condition | 6 to 8 month | 
| Total volume of propofol and fentanyl infused | Calculate dose consumption | 6 to 8 month |