Comparison of Sugammadex Administered at 1-2 Post Tetanic Counts (PTCs) or Better With Neostigmine Administered as Per Standard of Care to Reverse Rocuronium-Induced Neuromuscular Blockade in Adults Undergoing Elective Open Abdominal Procedure (19.4.334) (P05774)

Phase 3

Completed

• Conditions: Anesthesia
• Interventions: Drug: Sugammadex; Drug: Neostigmine; Drug: Rocuronium

• Registration Number: NCT00675792
• Lead Sponsor: Merck Sharp & Dohme LLC

Brief Summary

The primary purpose of this study is to compare the incidence of

residual neuromuscular blockade at the time of tracheal extubation after reversal of rocuronium bromide-induced neuromuscular blockade by 4 mg/kg sugammadex with that of 50 µg/kg neostigmine. Residual neuromuscular blockade is defined as the fourth twitch to first twitch (T4/T1) ratio of

\< 0.90.

Detailed Description

Undetected residual neuromuscular blockade is common in the post-anesthesia care

unit (PACU). In fact, 16%-42% of patients receiving intermediate-acting muscle

relaxants in the operating room have T4/T1 ratios \<0.7-0.8 in the PACU. Respiratory and pharyngeal muscle function can be adversely affected during minimal neuromuscular blockade. Studies in awake volunteers and surgical patients have demonstrated that T4/T1 ratios of 0.7 - 0.9 are associated with impaired airway protective reflexes, upper airway obstruction, a decreased hypoxic ventilatory response, and post-operative hypoxemia. The incidence and severity of residual neuromuscular blockade at the time of tracheal extubation will be evaluated to determine how these influence the length of stay in the operating room and PACU.

Study Timeline

• Study Start: 2008-05
• Study First Submitted: 2008-05-07
• Study First Submitted QC: 2008-05-07
• Study First Posted: 2008-05-12
• Primary Completion: 2008-09
• Study Completion: 2008-09
• Disposition First Submitted: 2009-05-04
• Disposition First Submitted QC: 2009-10-02
• Disposition First Posted: 2009-10-06
• Results First Submitted: 2013-05-21
• Results First Submitted QC: 2013-05-21
• Results First Posted: 2013-07-11
• Status Verified: 2015-02
• Last Update Submitted: 2015-02-24
• Last Update Posted: 2015-03-13

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• male or females who are >= 18 and <= 65 years of age
• classified by the American Society of Anesthesiologists (ASA) as Class 1 or 2 or 3;
• Body Mass Index (BMI) of <35 kg/m^2;
• is scheduled to undergo an elective open abdominal surgical procedure under general anesthesia requiring neuromuscular relaxation using rocuronium bromide (maintenance of neuromuscular blockade if required) for endotracheal intubation and requiring neuromuscular blockade reversal;
• is scheduled to undergo a surgical procedure in a position that does not interfere with the use of TOF-Watch® SX;
• is scheduled to undergo an elective open abdominal procedure expected to last <=4 hours (from start of skin incision to end of last stitch of the skin);
• have given written informed consent.

Exclusion Criteria

• participants for whom a difficult intubation is expected because of anatomical malformations;
• is known or suspected to have neuromuscular disorders that may impair neuromuscular blockade;
• is known or suspected to have significant renal dysfunction (e.g., creatinine clearance < 30 mL/min) ;
• is known or suspected to have significant hepatic dysfunction;
• is known or suspected to have a (family) history of malignant hyperthermia;
• is known or suspected to have an allergy to opioids, muscle relaxants or other medications used during general anesthesia;
• participants for whom the use of neostigmine and/or glycopyrrolate may be contraindicated;
• participants for whom a pre-established need for postoperative intensive care admission is expected;
• pregnant or breast-feeding females;
• have participated in a previous sugammadex clinical trial;

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Sugammadex	Sugammadex	4 mg/kg sugammadex
Sugammadex	Rocuronium	4 mg/kg sugammadex
Neostigmine	Neostigmine	50 µg/kg neostigmine
Neostigmine	Rocuronium	50 µg/kg neostigmine

Primary Outcome Measures

Name	Time	Method
Residual Neuromuscular Blockade Evidenced by T4/T1 Ratio at the Time of Tracheal Extubation	Up to the first 24 hours after tracheal extubation	Neuromuscular function was monitored by applying repetitive Train-Of-Four (TOF) electrical stimulations to the ulnar nerve every 15 seconds, and assessing twitch response at the adductor pollicis muscle with a TOF-Watch® SX. The magnitudes (heights) of the first and fourth twitches (T1 and T4) were used to calculate the T4/T1 ratio, where a higher T4/T1 ratio indicates a greater recovery from neuromuscular blockade, with a value of 1.0 indicating complete recovery. After anesthesia, when neuromuscular function was expected to be fully recovered, tracheal extubation was performed, at which time the T4/T1 ratio was measured, with any missing recovery times imputed.

Secondary Outcome Measures

Name	Time	Method
Time From Start of Administration of Investigational Medicinal Product (IMP) to Recovery of the T4/T1 Ratio to 0.9	Up to 1 hour after treatment	Neuromuscular function was monitored by applying repetitive TOF electrical stimulations to the ulnar nerve every 15 seconds, and assessing T1 and T4 twitch response at the adductor pollicis muscle with a TOF-Watch® SX. Nerve stimulation was continued until the T4/T1 ratio, which indicates the extent of recovery from neuromuscular blockade, achieved a ratio of 0.9, with imputed data included.
Time From Start of Administration of IMP to Recovery of the T4/T1 Ratio to 0.8	Up to 1 hour after treatment	Neuromuscular function was monitored by applying repetitive TOF electrical stimulations to the ulnar nerve every 15 seconds, and assessing T1 and T4 twitch response at the adductor pollicis muscle with a TOF-Watch® SX. Nerve stimulation was continued until the T4/T1 ratio, which indicates the extent of recovery from neuromuscular blockade, achieved a ratio of 0.8, with imputed data included.
Number of Participants With Evidence of Possible Interaction of Sugammadex With Endogenous Compounds or Exogenous Compounds Other Than Rocuronium Bromide	Up to 7 days after surgery	Evidence of adverse events due to a possible interaction of sugammadex with exogenous compounds or endogenous compounds other than rocuronium was recorded.
Number of Participants With Post-operative Complications	Up to 7 days after surgery	Post-operative complications include any of the following: procedural pain, nausea, vomiting, incision-site pain, constipation, headache, pyrexia, dizziness and pruritus.
Time From Start of Administration of IMP to Recovery of the T4/T1 Ratio to 0.7	Up to 1 hour after treatment	Neuromuscular function was monitored by applying repetitive TOF electrical stimulations to the ulnar nerve every 15 seconds, and assessing T1 and T4 twitch response at the adductor pollicis muscle with a TOF-Watch® SX. Nerve stimulation was continued until the T4/T1 ratio, which indicates the extent of recovery from neuromuscular blockade, achieved a ratio of 0.7, with imputed data included.