Effect of Neuromuscular Blockade on Operating Conditions and Overall Satisfaction During Spinal Surgery
Neuromuscular Blockade, Surgery, Anesthesia
About this trial
This is an interventional supportive care trial for Neuromuscular Blockade focused on measuring Neuromuscular blockade, Surgical rating scale, Rocuronium, Sugammadex, Spinal surgery, General anesthesia
Eligibility Criteria
Inclusion Criteria:
- American Society of Anesthesiologists (ASA) physical status I-II adult patients scheduled for elective spinal (cervical or lumbar) surgery under general anesthesia
Exclusion Criteria:
- Pregnancy
- Present medication known to interfere with neuromuscular blockade
- Diseases affecting neuromuscular transmission
- History of hypersensitivity on rocuronium or sugammadex
- Emergent spinal surgery
- Spinal surgeries which have lesions more than 3 spinal levels
- Spinal surgeries which have duration less than 1 hour
- Spinal surgeries which are not performed under prone position
- Spinal surgeries which are not performed under total intravenous anesthesia (TIVA).
- Patients who will have hemodynamic instability (mean blood pressure increase or fall of > 30% from baseline lasting for more than 5 min) during surgery
- Patients who will have blood loss > 1 L during surgery
- MEP monitored spinal surgeries
Sites / Locations
- Korea University Guro Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
deep neuromuscular blockade
restricted neuromuscular blockade
This arm will be given sufficient dose of rocuronium. In this Arm group, rocuronium will be administered to maintain deep neuromuscular blockade [NMB] (train-of-four [TOF] count 0, post-tetanic count [PTC] of 1-2 twitches) until the end of surgery and the reversal of NMB will be performed by sugammadex 4 mg/kg at the end of surgery'.
This arm will not be given sufficient dose of rocuronium. In this Arm group, sugammadex will be administered according to the prescribing indications (4 mg/kg for deep neuromuscular blockade [NMB] state or 2 mg/kg for moderate NMB or less) to reverse the NMB 10 min after position change (sugammadex 10 min after position change [a prone position]). Thereafter, muscle relaxants will not be injected any more throughout the surgery except the following situations: If the patients show any body movement during surgery or if surgeons express any complaint about muscle tone (the muscle tone: grade 3), rescue rocuronium 5 mg will be administered and the number of body movements and rescue rocuronium administration (dose) will be recorded.