To determine the advantage of giving a smaller dose of the muscle relaxant drug atracurium prior to giving total dose by measuring the amount of neuromuscular receptors blocked using TOF monitor

Not yet recruiting

Conditions: Medical and Surgical,

Registration Number: CTRI/2023/02/049888

Lead Sponsor: SHEETHAL BABY SCARIA

Brief Summary: Neuromuscular blocking agents are administered to provide excellent intubating conditions to

minimize airway trauma. Muscle relaxants are broadly classified into depolarizing and non-

depolarizing muscle relaxants. In anaesthesiology, non-depolarizing neuromuscular blocking agents

are used routinely for endotracheal intubation. In our study atracurium a steroidal non- depolarizing

neuromuscular blocking agent will be used.

To provide rapid and profound intubating conditions various techniques like combination of

muscle relaxants, timing principle, high dose non-depolarizing neuromuscular blocker and priming

principle are used. Priming principle is a technique in which a small dose (10% to 30% of intubation

dose) of non-depolarizing neuromuscular blocking agent is administered 3-5 minutes prior to

administration of large intubating dose to produce relatively rapid and profound neuromuscular

receptors blockade to ensure adequate intubating conditions for endotracheal

intubation. This technique is preferred in rapid sequence intubation and in patients in whom non-

depolarizing muscle relaxant succinylcholine is contraindicated

Neuromuscular function is evaluated using qualitative and quantitative clinical tests. Qualitative

evaluation employs peripheral nerve stimulators (PNSs) and assesses visually or tactilely the

response of the stimulated muscle. A standard PNS can provide several patterns of nerve

stimulation such as train of four (TOF), double-burst (DBS), tetanic and post-tetanic count (PTC)

or degree of fade. The TOF stimulation pattern was introduced aiming at a tool providing clinically

reliable information through all phases of neuromuscular blockade with simple peripheral nerve

stimulator. Commonly stimulated nerve is ulnar nerve innervating adductor pollicis muscle.

The aim of our study is to evaluate the percentage of Neuromuscular receptors blocked, time taken

for zero twitch and intubating condition with and without priming with atracurium, in adult patients

undergoing elective surgery under general anaesthesia.In the literature, there are studies assessing

intubating conditions, hemodynamic stability, presence of post-operative sore throat & hoarseness

and, post-operative residual curarisation using TOF monitoring. However, there are not many

studies quantifying the percentage of neuromuscular receptors blocked with and without priming

principle using TOF monitor.

We hypothesize that 80% of the neuromuscular receptors will be blocked in 3 minutes following

priming with Injection Atracurium 0.05 mg/kg (1/10th of intubating dose).

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 60

Inclusion Criteria

1.Patients undergoing elective surgery under General anesthesia requiring endotracheal intubation.
Patients aged between 18 and 59 years of either sex 3.
Patients with American Society of Anesthesiologists (ASA) class I 4.Patients with BMI 18 -30kg/m 2.

Exclusion Criteria

Surgeries involving anticipated risk of aspiration 2.
Patients with musculoskeletal disorders 3.
Patients with anticipated difficult airway 4.
Pregnant women.
Patients on aminoglycoside antibiotics.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
without priming in ASA I patients, undergoing elective surgeries under general anesthesia using TOF monitor	3 minutes
To compare the percentage of the neuromuscular receptors blocked at 3 minutes with and	3 minutes

Secondary Outcome Measures

Name	Time	Method
intubating conditions using Cooper scoring system	at 0 minutes of intubation
time taken for zero twitch after bolus intubating dose of injection atracurium	time taken for zero twitch in minutes

Trial Locations

Locations (1): ST JOHNS MEDICAL COLLEGE AND HOSPITAL
🇮🇳
Bangalore, KARNATAKA, India
ST JOHNS MEDICAL COLLEGE AND HOSPITAL
🇮🇳Bangalore, KARNATAKA, India
SHEETHAL BABY SCARIA
Principal investigator
9895007091
DRSHEETHALBABYSCARIA@GMAIL.COM