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Sugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade at the End of Kidney Transplantation Surgery

Primary Purpose

Kidney Transplant; Complications, Postoperative Residual Curarization, Postoperative Residual Weakness

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Sugammadex
Neostigmine
Sponsored by
University of Colorado, Denver
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Kidney Transplant; Complications

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • At least 18 years or older
  • Diagnosed with severe kidney dysfunction (defined by plasma creatinine clearance <30 mL/min)
  • Planning on kidney transplantation surgery at the University of Colorado Hospital.

Exclusion Criteria:

  • Patients unable to sign the informed consent
  • Pregnant women
  • Body Mass Index (BMI) > 40 kg/m2
  • Pre-existing oxygen or ventilatory dependency (24h use of oxygen or other noninvasive or invasive ventilatory support)
  • Patients with any pulmonary, neuromuscular or other disease that severely limits their respiratory functional status (e.g. unable to achieve 4 Metabolic Equivalent of Tasks, METs, such as climbing up 1 flight of stairs)
  • Presence of any contraindication for any of the study-related medications or interventions.

Sites / Locations

  • University of Colorado HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Sugammadex

Neostigmine

Arm Description

Sugammadex

Neostigmine

Outcomes

Primary Outcome Measures

Hypoventilation in post-anesthesia care unit (PACU)
Presence of one or more episodes of hypoventilation in PACU, adjusted to qTOF and other confounders

Secondary Outcome Measures

Time from NMBR administration to adequate NMBR
Intraoperative minutes from NMBR administration to qTOF T4/T1 equal or greater than 0.9
Time from NMBR administration to tracheal extubation
Intraoperative minutes from NMBR administration to tracheal extubation
Duration of surgery
Intraoperative minutes from surgical incision to closure (duration of surgery)
Duration of anesthesia
Intraoperative minutes from tracheal intubation to tracheal extubation (duration of anesthesia)
Presence of qTOF <0.9 in PACU
Incidence of qTOF <0.9 in PACU
Number of events of hypoventilation in PACU
Number of events of hypoventilation lasting 1 minute or longer in PACU
Accumulated minutes of hypoventilation in PACU
Accumulated minutes of hypoventilation in PACU
Delayed postoperative hypoventilation
Presence of one or more episodes of hypoventilation in postoperative floor, adjusted to qTOF and other confounders
Number of events of delayed postoperative hypoventilation
Number of events of hypoventilation lasting 1 minute or longer in the postoperative floor
Accumulated minutes of delayed postoperative hypoventilation
Accumulated minutes of hypoventilation in the postoperative floor
qTOF <0.9 in postoperative floor
Delayed detection of qTOF <0.9 in postoperative floor
Presence of postoperative pulmonary complications
Presence of predefined postoperative pulmonary complications, including respiratory failure, reintubation, ARDS, pneumonia, pneumothorax, atelectasis, pleural effusion or bronchospasm.
Dyspnea functional limitation
Score on standardized Patient-Reported Outcomes Measurement Information System (Promis) dyspnea functional limitation questionnaire score, compared to patient's baseline. Functional measurements include walking, lifting and activities of daily living. The higher the score on this instrument the more functional limitation (scale range is from 0 to 30)
Kidney graft function as measured by postoperative plasma clearance of creatinine (ClCr)
Predefined kidney graft function based on postoperative ClCr
Number of participants with kidney graft dysfunction
Predefined kidney graft negative outcomes including: postoperative increasing ClCr, reduced daily urine output, need for dialysis postoperatively, and/or diagnosis of delayed graft function or kidney graft rejection.
Rate of adverse events
Adverse events related to NMBR medications, including hypersensitivity and any other adverse events
Hospital resources utilization: total operating room time
Hospital resources utilization parameters, including total operating room time
Hospital resources utilization: PACU stay duration
Hospital resources utilization parameters, including total PACU stay duration
Hospital resources utilization: Hospital length of stay
Hospital resources utilization parameters, including total hospital stay duration
Hospital resources utilization: Rate of ICU admission
Hospital resources utilization parameters, including the need of ICU admission
Hospital resources utilization: ICU length of stay
Hospital resources utilization parameters, including total ICU stay duration

Full Information

First Posted
March 28, 2019
Last Updated
August 21, 2023
Sponsor
University of Colorado, Denver
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1. Study Identification

Unique Protocol Identification Number
NCT03923556
Brief Title
Sugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade at the End of Kidney Transplantation Surgery
Official Title
A Double-blind, Randomized, Parallel Study to Compare the Efficacy of Sugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade at the End of Kidney Transplantation Surgery in Patients With Severe Kidney Dysfunction
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 2, 2021 (Actual)
Primary Completion Date
September 30, 2023 (Anticipated)
Study Completion Date
December 30, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Colorado, Denver

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to compare two medications that reverse muscle paralysis at the end of kidney transplant surgery with the goal of reducing residual muscle weakness and insufficient respiratory function after surgery.
Detailed Description
This is a prospective randomized double-blind single center study on patients with severe kidney failure undergoing kidney transplantation surgery. Patients will have their muscles paralyzed during general anesthesia for surgery. At the end of surgery, muscle paralysis will be reversed with either neostigmine (control group) or sugammadex (intervention group). Residual muscle weakness and respiratory function will be monitored after surgery with a quantitative train-of-four (qTOF) monitor and a noninvasive continuous ventilation monitor. The investigators hypothesize that patients receiving sugammadex will have less residual muscle weakness and better respiratory function than patients receiving neostigmine. Respiratory and kidney function parameters and any adverse events will be collected during the hospital stay. Patients will contacted for a study follow up around 2 weeks after their surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Kidney Transplant; Complications, Postoperative Residual Curarization, Postoperative Residual Weakness

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderOutcomes Assessor
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Sugammadex
Arm Type
Experimental
Arm Description
Sugammadex
Arm Title
Neostigmine
Arm Type
Active Comparator
Arm Description
Neostigmine
Intervention Type
Drug
Intervention Name(s)
Sugammadex
Intervention Description
Administration of Sugammadex intravenously at a dose appropriate for the reversal of neuromuscular blockade (usually 2-4 mg/kg) at the end of the surgery before tracheal extubation
Intervention Type
Drug
Intervention Name(s)
Neostigmine
Intervention Description
Administration of Neostigmine intravenously at a dose appropriate for the reversal of neuromuscular blockade (usually 0.03-0.07 mg/kg) at the end of the surgery before tracheal extubation
Primary Outcome Measure Information:
Title
Hypoventilation in post-anesthesia care unit (PACU)
Description
Presence of one or more episodes of hypoventilation in PACU, adjusted to qTOF and other confounders
Time Frame
Within up to 3 hours after the end of surgery
Secondary Outcome Measure Information:
Title
Time from NMBR administration to adequate NMBR
Description
Intraoperative minutes from NMBR administration to qTOF T4/T1 equal or greater than 0.9
Time Frame
Within minutes from NMBR administration intraoperatively
Title
Time from NMBR administration to tracheal extubation
Description
Intraoperative minutes from NMBR administration to tracheal extubation
Time Frame
Within minutes from NMBR administration intraoperatively
Title
Duration of surgery
Description
Intraoperative minutes from surgical incision to closure (duration of surgery)
Time Frame
During operating room stay
Title
Duration of anesthesia
Description
Intraoperative minutes from tracheal intubation to tracheal extubation (duration of anesthesia)
Time Frame
During operating room stay
Title
Presence of qTOF <0.9 in PACU
Description
Incidence of qTOF <0.9 in PACU
Time Frame
Within up to 3 hours after the end of surgery
Title
Number of events of hypoventilation in PACU
Description
Number of events of hypoventilation lasting 1 minute or longer in PACU
Time Frame
Within up to 3 hours after the end of surgery
Title
Accumulated minutes of hypoventilation in PACU
Description
Accumulated minutes of hypoventilation in PACU
Time Frame
Within up to 3 hours after the end of surgery
Title
Delayed postoperative hypoventilation
Description
Presence of one or more episodes of hypoventilation in postoperative floor, adjusted to qTOF and other confounders
Time Frame
Within up to 3 postoperative days, counting from PACU discharge
Title
Number of events of delayed postoperative hypoventilation
Description
Number of events of hypoventilation lasting 1 minute or longer in the postoperative floor
Time Frame
Within up to 3 postoperative days, counting from PACU discharge
Title
Accumulated minutes of delayed postoperative hypoventilation
Description
Accumulated minutes of hypoventilation in the postoperative floor
Time Frame
Within up to 3 postoperative days, counting from PACU discharge
Title
qTOF <0.9 in postoperative floor
Description
Delayed detection of qTOF <0.9 in postoperative floor
Time Frame
Within up to 3 postoperative days, counting from PACU discharge
Title
Presence of postoperative pulmonary complications
Description
Presence of predefined postoperative pulmonary complications, including respiratory failure, reintubation, ARDS, pneumonia, pneumothorax, atelectasis, pleural effusion or bronchospasm.
Time Frame
Within up to 3 postoperative days and at 14 +/- 3 days after surgery
Title
Dyspnea functional limitation
Description
Score on standardized Patient-Reported Outcomes Measurement Information System (Promis) dyspnea functional limitation questionnaire score, compared to patient's baseline. Functional measurements include walking, lifting and activities of daily living. The higher the score on this instrument the more functional limitation (scale range is from 0 to 30)
Time Frame
Within up to 14 +/- 3 days after surgery
Title
Kidney graft function as measured by postoperative plasma clearance of creatinine (ClCr)
Description
Predefined kidney graft function based on postoperative ClCr
Time Frame
Within up to 3 postoperative days and at 14 +/- 3 days after surgery
Title
Number of participants with kidney graft dysfunction
Description
Predefined kidney graft negative outcomes including: postoperative increasing ClCr, reduced daily urine output, need for dialysis postoperatively, and/or diagnosis of delayed graft function or kidney graft rejection.
Time Frame
Within up to 3 postoperative days and at 14 +/- 3 days after surgery
Title
Rate of adverse events
Description
Adverse events related to NMBR medications, including hypersensitivity and any other adverse events
Time Frame
Within up to 3 postoperative days
Title
Hospital resources utilization: total operating room time
Description
Hospital resources utilization parameters, including total operating room time
Time Frame
During operating room stay
Title
Hospital resources utilization: PACU stay duration
Description
Hospital resources utilization parameters, including total PACU stay duration
Time Frame
During PACU stay
Title
Hospital resources utilization: Hospital length of stay
Description
Hospital resources utilization parameters, including total hospital stay duration
Time Frame
Within up to 14 +/- 3 days after surgery
Title
Hospital resources utilization: Rate of ICU admission
Description
Hospital resources utilization parameters, including the need of ICU admission
Time Frame
Within up to 14 +/- 3 days after surgery
Title
Hospital resources utilization: ICU length of stay
Description
Hospital resources utilization parameters, including total ICU stay duration
Time Frame
Within up to 14 +/- 3 days after surgery

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: At least 18 years or older Diagnosed with severe kidney dysfunction (defined by plasma creatinine clearance <30 mL/min) Planning on kidney transplantation surgery at the University of Colorado Hospital. Exclusion Criteria: Patients unable to sign the informed consent Pregnant women Body Mass Index (BMI) > 40 kg/m2 Pre-existing oxygen or ventilatory dependency (24h use of oxygen or other noninvasive or invasive ventilatory support) Patients with any pulmonary, neuromuscular or other disease that severely limits their respiratory functional status (e.g. unable to achieve 4 Metabolic Equivalent of Tasks, METs, such as climbing up 1 flight of stairs) Presence of any contraindication for any of the study-related medications or interventions.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ana Fernandez-Bustamante, M.D., Ph.D.
Phone
303-724-2935
Email
ana.fernandez-bustamante@cuanschutz.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ana Fernandez-Bustamante, M.D., Ph.D.
Organizational Affiliation
University of Colorado School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Colorado Hospital
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ana Fernandez-Bustamante, MD, PhD
Phone
303-724-2935

12. IPD Sharing Statement

Plan to Share IPD
No

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Sugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade at the End of Kidney Transplantation Surgery

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