Effect of Calcium Chloride on Recovery From Neuromuscular Blockade

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the effect of calcium chloride against residual neuromuscular blockade at the end of general anesthesia

Detailed Description
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During general anesthesia, neuromuscular blocking agent is administered to facilitate endotracheal intubation and the view of operative field. The neuromuscular blockade should be reversed at the end of anesthesia to recover spontaneous breathing of the patient. Residual neuromuscular blockade (RNMB) is defined as train of-four ratio < 0.9. RNMB is a risk factor for postoperative pulmonary complication and increases postoperative mortality. Neostigmine is acetylcholinesterase inhibitor routinely used at the end of anesthesia to prevent RNMB. A meta-analysis, however, showed that 40 percent of patients who received intermediate-acting neuromuscular blocking agent during anesthesia showed RNMB in PACU. Calcium triggers the release of acetylcholine from the motor nerve terminal and enhances excitation-contraction coupling in muscle. Increasing calcium concentrations decreased the sensitivity to dTc and pancuronium in an animal muscle-nerve model. The effect of calcium chloride on residual neuromuscular blockade is not studied yet. The purpose of this study is to evaluate the effect of calcium chloride on residual neuromuscular blockade at the end of general anesthesia

Official Title
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Effect of Calcium Chloride on Recovery From Neuromuscular Blockade in Patients Undergoing General Anesthesia

Conditions
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Residual Neuromuscular Blockade

Intervention / Treatment
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* Drug: Calcium
* Drug: control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-65 yr Body mass index 15.0-25.0 kg/m2 American Society of Anesthesiologists physical status I-III Scheduled for elective surgery with an expected duration of more than 60 min under general anesthesia with endotracheal intubation Exclusion Criteria: Suspected difficulty airway Bronchial asthma, chronic obstructive pulmonary disease Neuromuscular disease Hepatic or renal dysfunction. Taking medications that might influence the effect of neuromuscular blocking agents Allergy to the medication that used in this trial Pregnant, or breastfeeding state Suspected malignant hyperthermia Contraindication to the medication that used in this trial Hypercalcemia

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Calcium<br>Administration of calcium chloride 5 mg/kg along with neostigmine 25 mcg/kg + atropine 15 mcg/kg | Drug: Calcium<br>* Administration of calcium chloride 5 mg/kg along with neostigmine 25 mcg/kg + atropine 15 mcg/kg<br>|
| Placebo Comparator: control<br>In the control group, all the procedures were the same with calcium group, except for the fact that calcium chloride is not administered | Drug: control<br>* In the control group, all the procedures were the same with calcium group, except for the fact that calcium chloride is not administered<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to train of-four ratio of 0.9. | Train of-four will be measured using acceleromyograph. | At 10 minutes (expected aeverage) after the surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Train of-four ratio | Train of-four will be measured using accelerography. | At 5, 10, 20 minutes after the administration of reversal drug | 
| Length of PACU stay |  | At 60 minutes (expected average) after the surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neuromuscular blockade reversal, TOF ratio, Calcium chloride