An interventional study of A continuous intravenous infusion of 0.5-0.6 mg/kg/h Rocuronium Bromide Intravenous Solution (50 Mg/5 mL) to keep the target neuromuscular blockade (PTC = 1-2). and A continuous intravenous infusion of 0.2-0.3 mg/kg/h Rocuronium Bromide Intravenous Solution (50 Mg/5 mL) to keep the target neuromuscular blockade (TOF = 1-2). in Neuromuscular Blockade, sponsored by The First Affiliated Hospital with Nanjing Medical University. Completed at 1 site in China. Open to participants aged 40 Years to 80 Years. Per ClinicalTrials.gov, last updated 2020-09-24.
Sponsored by The First Affiliated Hospital with Nanjing Medical University · Not applicable, Interventional, and Treatment
On the basis of moderate pneumoperitoneum pressure(10 mmHg), this study evaluates the effect of different level of neuromuscular blockade to gastrointestinal barrier function during laparoscopic gastrectomy. 83 patients are randomized to 2 arms ,The patients in deep neuromuscular blockade group(group D, PTC=1-2)will receive high dose rocuronium (0.5-0.6 mg/kg/h) ;While the patients in moderate neuromuscular blockade group(group M, TOF=1-2)will receive moderate dose rocuronium (0.2-0.3 mg/kg/h)
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Exclusion Criteria:
Patients undergoing elective laparoscopic surgery for gastrectomy will be randomized to receive deep neuromuscular blockade (post-tetanic count = 1-2) using high dose rocuronium.
Drug: A continuous intravenous infusion of 0.5-0.6 mg/kg/h Rocuronium Bromide Intravenous Solution (50 Mg/5 mL) to keep the target neuromuscular blockade (PTC = 1-2).
Patients undergoing elective laparoscopic surgery for gastrectomy will be randomized to receive moderate neuromuscular blockade (train-of-four count = 1-2) using moderate dose rocuronium.
Drug: A continuous intravenous infusion of 0.2-0.3 mg/kg/h Rocuronium Bromide Intravenous Solution (50 Mg/5 mL) to keep the target neuromuscular blockade (TOF = 1-2).
50 patients undergoing laparoscopic gastrectomy surgery will be allocated to group D. A continuous intravenous infusion of 0.5-0.6 mg/kg/h rocuronium to keep the target neuromuscular blockade (PTC = 1-2).
33 patients undergoing laparoscopic gastrectomy surgery will be allocated to group M. A continuous intravenous infusion of 0.2-0.3 mg/kg/h rocuronium to keep the target neuromuscular blockade (TOF = 1-2).
Plasma Concentration of D-lactic Acid Before the Surgery
The level of D-lactic acid can indicate the damage to the gastrointestinal barrier .
Time frame: 1 day before the surgery
Plasma Concentration of Diamine Oxidase (DAO) Before the Surgery
The level of DAO can indicate the damage to the gastrointestinal barrier .
Time frame: 1 day Before the Surgery
Total Number of Operational Taxonomic Units (OUTs) of Intestinal Microbiota
Intestinal microbiota was analyzed by 16S rRNA sequencing. To be specific, first, DNA was extracted and quantified. Bacterial 16S rRNA genes of the V3-V4 region were amplified from extracted DNA using the barcoded primers (5'- CCTACGGRRBGCASCAGKVRVGAAT-3') and (5'- GGACTACNVGGGTWTCTAATCC-3'). PCR reactions were performed and the PCR mixture applied to the PCR amplifier. Then, the PCR products were checked for size and specificity by agarose gel electrophoresis and purified. Finally, high-throughput sequencing was performed using the Illumina MiSeq platform. The raw reads were filtered to remove low quality sequences and the filtered data were further merged into tags by FLASH(Version 1.2.7). Then the Uchime algorithm in Usearch software was applied to remove chimeric tags. Resulting tags for each sample were clustered into operational taxonomic units(OTUs) at the level of 97% similarity. Higher values represent a more abundant amount of bacteria in gut.
Time frame: the first time of defecation after operation
Postoperative Exhaust Time
It's a regular measurement to evaluate the function of gastrointestinal tract . It is calculated from the end of the operation to the time of exhaust.
Time frame: It is calculated from the end of the operation to the time of exhaust.
Plasma Concentration of D-lactic Acid 24 h After the Surgery
The level of D-lactic acid can indicate the damage to the gastrointestinal barrier .
Time frame: 24 h after the surgery
Plasma Concentration of Diamine Oxidase (DAO) 24 h After the Surgery
The level of DAO can indicate the damage to the gastrointestinal barrier .
Time frame: 24 h after the Surgery
Relative Abundance of Intestinal Microbiota
Intestinal microbiota is one of the factors related to the recovery of intestinal function. It can be analyzed by 16S rRNA sequencing of the postoperative feces.
Time frame: the first time of defecation after operation
16s rRNA Sequencing of Postoperative Feces
Alpha and Beta diversity; relative abundance of gut microbiota. Alpha diversity includes Chao 1 index, Shannon index, and Simpson index. A higher value of Chao 1 index corresponds to more abundant number of microbiota. A higher value of Shannon index corresponds to more abundance. And A higher value of Simpson index corresponds to less diversity. Bata diversity was assessed by PCoA analysis. A three dimensional scatter plot was presented to visualize the similarities and differences between the two groups.
Time frame: the first time of defecation after operation
Duration of Surgery
Time from the first dose of anesthetic to the end of the surgery
Time frame: From the first dose of anesthetic to the end of the surgery
Surgical Condition Scores Rated by Surgeons
evaluation of the surgical condition by 5 point scale: 5 points: optimal; 4 points: good; 3 points: acceptable; 2 points: poor; 1 point: extremely poor.
Time frame: During operation, within 2 hours
Duration of CO2 Pneumoperitoneum
Time from the beginning to the end of CO2 pneumoperitoneum
Time frame: from the beginning to the end of CO2 pneumoperitoneum
Duration of Postoperative Hospital Stay
Duration from the day of surgery to the day the patient discharged from the hospital
Time frame: from the end of surgery to the time of being discharged from hospital
Postoperative VAS (12 h After Surgery, Rest State)
VAS pain score: 0 - completely painless, 10 - unbearable pain.
Time frame: 12 h after surgery
Postoperative VAS (12 h After Surgery, Active State)
VAS pain score: 0 - completely painless, 10 - unbearable pain.
Time frame: 12 h after surgery
Postoperative VAS (24 h After Surgery, Rest State)
VAS pain score: 0 - completely painless, 10 - unbearable pain.
Time frame: 24 h after surgery
Postoperative VAS (24 h After Surgery, Active State)
VAS pain score: 0 - completely painless, 10 - unbearable pain.
Time frame: 24 h after surgery
Postoperative VAS (48 h After Surgery, Rest State)
VAS pain score: 0 - completely painless, 10 - unbearable pain.
Time frame: 48 h after surgery
Postoperative VAS (48 h After Surgery, Active State)
VAS pain score: 0 - completely painless, 10 - unbearable pain.
Time frame: 48 h after surgery
Surgical Condition Scores Rated by Surgeons (Average Scores)
evaluation of the surgical condition by 5 point scale: 5 points: optimal; 4 points: good; 3 points: acceptable; 2 points: poor; 1 point: extremely poor.
Time frame: during surgery
| Milestone | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Started | 50 | 33 |
| Completed | 46 | 31 |
| Not completed | 4 | 2 |
The level of D-lactic acid can indicate the damage to the gastrointestinal barrier .
| ng/ml | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Plasma Concentration of D-lactic Acid Before the Surgery | 1100.4 ± 156.6 | 1087.8 ± 146.0 |
The level of DAO can indicate the damage to the gastrointestinal barrier .
| U/L | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Plasma Concentration of Diamine Oxidase (DAO) Before the Surgery | 15.5 ± 3.0 | 16.4 ± 3.6 |
Intestinal microbiota was analyzed by 16S rRNA sequencing. To be specific, first, DNA was extracted and quantified. Bacterial 16S rRNA genes of the V3-V4 region were amplified from extracted DNA using the barcoded primers (5'- CCTACGGRRBGCASCAGKVRVGAAT-3') and (5'- GGACTACNVGGGTWTCTAATCC-3'). PCR reactions were performed and the PCR mixture applied to the PCR amplifier. Then, the PCR products were checked for size and specificity by agarose gel electrophoresis and purified. Finally, high-throughput sequencing was performed using the Illumina MiSeq platform. The raw reads were filtered to remove low quality sequences and the filtered data were further merged into tags by FLASH(Version 1.2.7). Then the Uchime algorithm in Usearch software was applied to remove chimeric tags. Resulting tags for each sample were clustered into operational taxonomic units(OTUs) at the level of 97% similarity. Higher values represent a more abundant amount of bacteria in gut.
| units | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Total Number of Operational Taxonomic Units (OUTs) of Intestinal Microbiota | 1695 | 1287 |
It's a regular measurement to evaluate the function of gastrointestinal tract . It is calculated from the end of the operation to the time of exhaust.
| hour | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Postoperative Exhaust Time | 58.9 ± 15.9 | 70.5 ± 26.6 |
The level of D-lactic acid can indicate the damage to the gastrointestinal barrier .
| ng/ml | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Plasma Concentration of D-lactic Acid 24 h After the Surgery | 1230.7 ± 138.4 | 1297.5 ± 147.8 |
The level of DAO can indicate the damage to the gastrointestinal barrier .
| U/L | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Plasma Concentration of Diamine Oxidase (DAO) 24 h After the Surgery | 18.1 ± 3.3 | 26.5 ± 4.7 |
Intestinal microbiota is one of the factors related to the recovery of intestinal function. It can be analyzed by 16S rRNA sequencing of the postoperative feces.
| percentage of all intestinal microbiota | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Class-Deltaproteobacteria | 0.0010483424321 ± 0.00 | 0.0010483424321 ± 0.00 |
| Class-Flavobacteriia | 0 ± 0 | 0.000019780046 ± 0 |
| Order-Desulfovibrionales | 0.0081493789065 ± 0 | 0.0010483424321 ± 0 |
| Order-Flavobacteriales | 0 ± 0 | 0.00003956 ± 0 |
| Family-[Tissierellaceae] | 0.0021362449560 ± 0 | 0.0001186802753 ± 0 |
| Family-Fusobacteriaceae | 0.0005340612390 ± 0 | 0.0196020254767 ± 0 |
| Family-Desulfovibrionaceae | 0.0081493789065 ± 0 | 0.0010285623862 ± 0 |
| Family-[Weeksellaceae] | 0 ± 0 | 0.000019780046 ± 0 |
| Genus-Blautia | 0.0097021125088 ± 0 | 0.0024725057362 ± 0 |
| Genus-Dialister | 0.0002175805047 ± 0 | 0.0042724899121 ± 0 |
| Genus-Collinsella | 0.0024329456444 ± 0 | 0 ± 0 |
| Genus-Fusobacterium | 0.0005340612390 ± 0 | 0.0196020254767 ± 0 |
| Genus-Bilophila | 0.0050636917477 ± 0 | 0.0010087823403 ± 0 |
| Genus-Aggregatibacter | 0 ± 0 | 0.0007120816520 ± 0 |
| Genus-Megasphaera | 0.000059340138 ± 0 | 0.0019780045889 ± 0 |
| Genus-Neisseria | 0 ± 0 | 0.000019780046 ± 0 |
| Genus-Selenomonas | 0 ± 0 | 0.000039560092 ± 0 |
| Genus-Roseburia | 0.000019780046 ± 0 | 0 ± 0 |
| Genus-TG5 | 0 ± 0 | 0.000019780045 ± 0 |
Alpha and Beta diversity; relative abundance of gut microbiota. Alpha diversity includes Chao 1 index, Shannon index, and Simpson index. A higher value of Chao 1 index corresponds to more abundant number of microbiota. A higher value of Shannon index corresponds to more abundance. And A higher value of Simpson index corresponds to less diversity. Bata diversity was assessed by PCoA analysis. A three dimensional scatter plot was presented to visualize the similarities and differences between the two groups.
| score on a scale | Deep Neuromuscular Blockade Group (Group D) | Moderate Neuromuscular Blockade Group (Group M) |
|---|---|---|
| alpha diversity - Chao1 | 763.7 ± 183.7 | 599.3 ± 164.0 |
| alpha diversity - Shannon index | 4.93 ± 1.0 | 4.15 ± 0.9 |
| alpha diversity - Simpson index | 0.9 ± 0.07 | 0.83 ± 0.1 |
Time from the first dose of anesthetic to the end of the surgery
| minutes | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Duration of Surgery | 155.0 ± 34.2 | 174.6 ± 34.9 |
evaluation of the surgical condition by 5 point scale: 5 points: optimal; 4 points: good; 3 points: acceptable; 2 points: poor; 1 point: extremely poor.
| Participants | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| 1 point | 0 | 1 |
| 2 points | 0 | 4 |
| 3 points | 3 | 16 |
| 4 points | 9 | 7 |
| 5 points | 34 | 3 |
Time from the beginning to the end of CO2 pneumoperitoneum
| minute | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Duration of CO2 Pneumoperitoneum | 132.3 ± 31.2 | 147.0 ± 34.8 |
Duration from the day of surgery to the day the patient discharged from the hospital
| days | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Duration of Postoperative Hospital Stay | 9.2 ± 4.0 | 9.1 ± 5.1 |
VAS pain score: 0 - completely painless, 10 - unbearable pain.
| units on a scale | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Postoperative VAS (12 h After Surgery, Rest State) | 2.2 ± 1.4 | 2.1 ± 1.4 |
VAS pain score: 0 - completely painless, 10 - unbearable pain.
| units on a scale | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Postoperative VAS (12 h After Surgery, Active State) | 3.6 ± 1.6 | 3.8 ± 1.4 |
VAS pain score: 0 - completely painless, 10 - unbearable pain.
| points | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Postoperative VAS (24 h After Surgery, Rest State) | 1.3 ± 1.0 | 1.5 ± 1.2 |
VAS pain score: 0 - completely painless, 10 - unbearable pain.
| units on a scale | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Postoperative VAS (24 h After Surgery, Active State) | 2.7 ± 1.3 | 3.1 ± 1.4 |
VAS pain score: 0 - completely painless, 10 - unbearable pain.
| units on a scale | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Postoperative VAS (48 h After Surgery, Rest State) | 0.4 ± 0.8 | 0.7 ± 1.0 |
VAS pain score: 0 - completely painless, 10 - unbearable pain.
| units on a scale | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Postoperative VAS (48 h After Surgery, Active State) | 1.5 ± 1.1 | 1.5 ± 1.1 |
evaluation of the surgical condition by 5 point scale: 5 points: optimal; 4 points: good; 3 points: acceptable; 2 points: poor; 1 point: extremely poor.
| units on a scale | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) |
|---|---|---|
| Surgical Condition Scores Rated by Surgeons (Average Scores) | 4.6 ± 0.6 | 3.2 ± 0.9 |
Collected over through study completion, an average of 2 weeks. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Deep Neuromuscular Blockade(Group D) | 0/77 (0%) | 0/77 (0%) | 0/77 (0%) |
| Moderate Neuromuscular Blockade (Group M) | 0/77 (0%) | 0/77 (0%) | 0/77 (0%) |
| Age, Continuous(years) | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) | Total |
|---|---|---|---|
| Mean | 60.6 ± 10.8 | 60.0 ± 8.1 | 60.4 ± 9.8 |
| Sex: Female, Male(Participants) | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) | Total |
|---|---|---|---|
| Female | 17 | 9 | 26 |
| Male | 29 | 22 | 51 |
| Race and Ethnicity Not Collected(Participants) | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) | Total |
|---|---|---|---|
| Count of participants | — | — | 0 |
| Region of Enrollment(participants) | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) | Total |
|---|---|---|---|
| China | 46 | 31 | 77 |
| Body mass index (BMI)(kg/m^2) | Deep Neuromuscular Blockade(Group D) | Moderate Neuromuscular Blockade (Group M) | Total |
|---|---|---|---|
| Mean | 23.6 ± 2.8 | 24.3 ± 2.7 | 23.92 ± 2.76 |
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The First Affiliated Hospital with Nanjing Medical University