Clinical trial NCT06102915: Rocuronium vs Cis-atracurium: Do Rocuronium Still 'ROCKS' In Coronary Artery Bypass Grafting
Official title: Rocuronium vs Cis-atracurium: Do Rocuronium Still 'ROCKS' In Coronary Artery Bypass Grafting
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Neuromuscular Blockade
Postoperative Pulmonary Atelectasis
Postoperative Pulmonary Complication
Coronary Artery Disease
Coronary Artery Bypass Grafting
Hypothermic Cardiopulmonary Bypass
Keywords: Neuromuscular Blockade
Postoperative Pulmonary Atelectasis
postoperative pulmonary complication
Coronary Artery Disease
coronary artery bypass grafting
hypothermic cardiopulmonary bypass
rocuronium
cis-atracurium
Lead sponsor: Institut Jantung Negara
Sponsor class: OTHER
First posted: 2023-10-26
Enrollment: 289
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: All patients that undergo general anaesthesia for CABG surgery requiring neuromuscular blockade of either rocuronium or cis-atracurium

Brief summary: The current trend in most cardiac surgeries was to use rocuronium as it provides faster recovery in train-of-four ratio compared to other aminosteroid non-depolarising neuromuscular blocker. However, as most cardiac centres' standard of care does not perform any neuromuscular monitoring nor antagonism of neuromuscular blockade effect, residual neuromuscular blockade could potentially be the key to delayed extubation. As such, Cis-atracurium's organ-independent Hofmann elimination could be in favour.


Eligibility criteria: Inclusion Criteria:

* All patients that undergo general anaesthesia for CABG surgery requiring neuromuscular blockade of either rocuronium or cis-atracurium

Exclusion Criteria:

1. Recent history of pulmonary infection four weeks before surgery
2. Exposed to both neuromuscular blockade within 24 hours perioperatively
3. Patients intubated or on tracheostomies pre-operatively
4. Any missing or incomplete data

Primary outcomes:
measure: Incidence of postoperative pulmonary complication
timeFrame: 6 months
Secondary outcomes:
measure: Ventilation hours in ICU
timeFrame: 6 months
measure: Requirements for Non-invasive ventilation
timeFrame: 6 months
measure: Incidence of postoperative atrial fibrillation
timeFrame: 6 months
Other outcomes:
Locations:
city: Kuala Lumpur
country: Malaysia
facility: Institut Jantung Negara
Study officials:
affiliation: IJN
name: SONG LIN LOW, MBBS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Thomas R, Smith D, Strike P. Prospective randomised double-blind comparative study of rocuronium and pancuronium in adult patients scheduled for elective 'fast-track' cardiac surgery involving hypothermic cardiopulmonary bypass. Anaesthesia. 2003 Mar;58(3):265-71. doi: 10.1046/j.1365-2044.2003.30362.x.
citation: Hemmerling TM, Russo G, Bracco D. Neuromuscular blockade in cardiac surgery: an update for clinicians. Ann Card Anaesth. 2008 Jul-Dec;11(2):80-90. doi: 10.4103/0971-9784.41575.
citation: Murphy GS, Szokol JW, Vender JS, Marymont JH, Avram MJ. The use of neuromuscular blocking drugs in adult cardiac surgery: results of a national postal survey. Anesth Analg. 2002 Dec;95(6):1534-9, table of contents. doi: 10.1097/00000539-200212000-00012.
citation: Naguib M, Samarkandi AH, Ammar A, Elfaqih SR, Al-Zahrani S, Turkistani A. Comparative clinical pharmacology of rocuronium, cisatracurium, and their combination. Anesthesiology. 1998 Nov;89(5):1116-24. doi: 10.1097/00000542-199811000-00011.
citation: Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017 Mar 1;118(3):317-334. doi: 10.1093/bja/aex002.