ThyroidectomyNCT06162390
Optimal Concentration of Remifentanil for NIM Tube Intubation With Low-dose NMBA
A study testing Remifentanil in people with Thyroidectomy, run by Kyungpook National University Chilgok Hospital at 1 site in South Korea.
Trial summary
During thyroid surgery, Intraoperative Neuromonitoring (IONM) plays a crucial role in preventing serious complications such as bilateral vocal cord paralysis. It achieves this by detecting damage to the recurrent laryngeal nerve (RLN) and predicting the RLN's functional status. Read more about this study
- Who is it for?
- Ages 20 to 60 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Thyroidectomy
- What is being tested?
- Remifentanil
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 21 participants
- Where
- 1 siteSouth Korea
- Study dates
- 20 Nov 2023to 20 Mar 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 60 years
- Women only
- Healthy volunteers accepted
- Adult
Who may be able to join
- All female aged 20-60
- ASA (American Society of Anesthesiologists) physical status I or II
- who scheduled for thyroidectomy under intraoperative neuromonitoring with a nerve integrity monitoring tube (NIM tube)
Who cannot join
- Patients anticipated to experience challenging intubation.
- Patients who have had an upper respiratory tract infection within the past 2 weeks.
- Patients with a history of heart, lung, and kidney diseases.
- Patients with a body mass index (BMI) of 30 kg/m² or higher.
- Patients currently taking analgesics.
- Patients expressing a desire not to participate in the study.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Optimal Concentration of Remifentanil for Achieving Excellent Intubating Condition During Low-dose Neuromuscular Blocking Agent Administration for Intraoperative Neuromonitoring Using Nerve Integrity Monitoring Tube
During thyroid surgery, Intraoperative Neuromonitoring (IONM) plays a crucial role in preventing serious complications such as bilateral vocal cord paralysis. It achieves this by detecting damage to the recurrent laryngeal nerve (RLN) and predicting the RLN's functional status. The utilization of Nerve Integrity Monitoring tubes (NIM tubes) is on the rise for effective IONM. As IONM relies on observing electromyographic (EMG) responses to direct electrical nerve stimulation, the routine use of neuromuscular blocking agents (NMBAs) in general anesthesia can impact the interpretation of IONM results and potentially reduce sensitivity to nerve responses to stimulation. However, the use of NMBAs is essential for ensuring smooth endotracheal intubation in patients undergoing general anesthesia. Numerous studies suggest that NMBA usage provides superior intubation conditions and reduces vocal cord complications compared to scenarios without NMBA.
Various regimens for neuromuscular blockade methods are employed during IONM in thyroid surgery, ranging from not using NMBAs at all to using a full dose of NMBA for intubation. This is followed by the administration of sugammadex, an NMBA reversal agent, before nerve monitoring. One of the methods known for providing satisfactory intubation conditions while ensuring the quality of EMG signals during IONM in thyroid surgery is using rocuronium at an ED95 dose of 0.3 mg/kg. This approach is considered suitable for most IONM scenarios. However, when adequate muscle relaxation is not achieved, not all patients can undergo intubation, necessitating a strategy for appropriate intubation conditions.
Read more
Historically, it has been reported that achieving satisfactory intubation conditions without the use of NMBA during general anesthesia requires higher amounts of propofol and opioids. Therefore, the assumption is made that using remifentanil, an opioid used in total intravenous anesthesia (TIVA), at an appropriate concentration can provide acceptable intubation conditions with minimal NMBA use for patients undergoing IONM.
This study aims to determine the optimal concentration of remifentanil needed to achieve excellent intubation conditions in patients undergoing thyroid surgery with IONM using rocuronium 0.3 mg/kg as the NMBA during TIVA
- Conditions
- Thyroidectomy
- Being tested
- Remifentanil
- Keywords
- Intraoperative nerve monitoring, Neuromuscular blocking agents, Remifentanil
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
RemifentanilDrug
Following a sequential allocation scheme, the predetermined Ce of remifentanil for each patient will be determined by the Dixon up-and-down method. The Ce of remifentanil for the first patient will be 4.0 ng/ml, and then the remifentanil Ce will be increased or decreased in 0.5 ng/ml increments for subsequent patients depending on the success or failure of intubation.
The Ce of remifentanil to provide acceptable intubation at low dose neuromuscular blockade, the primary outcome, will be determined by obtaining seven crossovers of patients with "acceptable intubation"/"unacceptable intubation" and then calculating the mean of the midpoint doses for each independent pair of patients. According to previous studies that estimated EC50 by Dixon's up-and-down method, 6-8 "failure/success crossover pairs" are required, so this study aims to collect independent data of 7 pairs of "intubation acceptable/unacceptable" patients.
| Study group | Role | What they receive |
|---|---|---|
| Remifentanil for NIM tube intubation | Experimental | Not described Receives: Drug: Remifentanil |
What is being measured
The primary outcome is the main question the study is designed to answer.
Optimal effect-site concentration (Ce) of remifentanil
Finding the Ce of remifentanil that provides acceptable condition of tracheal intubation when administering a low-dose NMBA is the aim of the study. The Ce of remifentanil for the first patient is 4.0 ng/ml, and then the Ce is increased or decreased in 0.5 ng/ml increments for subsequent patients depending on the success or failure of intubation. About 3 minutes after administering rocuronium 0.3 mg/kg, NIM tube will be intubated. At this time, the intubation condition will be evaluated using the grading system described by Fuchs-Buder. There are 4 items (jaw relaxation, vocal cord position, cough response, and limb movement) that are evaluated, and a total score can be calculated based on them: 1 point if all items are E, 3 points if even one item is P, and 2 points for the rest. A tracheal intubation condition rating of 1 or 2 indicates that the intubation is acceptable (successful), and a rating of 3 indicates that the intubation is unacceptable (unsuccessful).
Measured: During the tracheal intubation
Secondary outcomes (4)
The rating of each item of the grading system of the tracheal intubation condition
There are 4 items (jaw relaxation, vocal cord position, cough response, and limb movement) in the grading system described by Fuchs-Buder. We will also evaluate the grade of these items.
Measured: During the tracheal intubation
Total dose of remifentanil administered until tracheal intubation
Measured: From the start of the anesthesia induction to tracheal intubation
Incidence of hypotension and bradycardia
Measured: From the start of the anesthesia induction to tracheal intubation
Doses of agents (ephedrine and atropine) administered to treat hypotension and bradycardia
Measured: From the start of the anesthesia induction to tracheal intubation
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Dec 2023
- Study start20 Nov 2023
- Primary completion10 Mar 2024
- Study completion20 Mar 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for ThyroidectomyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Sequential
- Masking
- None (open label)
- Enrolment
- 21 participants (actual)
Sponsor and investigators
- Lead sponsor
- Kyungpook National University Chilgok Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Sung Hye Byun, Kyungpook National University Chilgok Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06162390
- Sponsor's protocol ID
- KNUCH 2023-10-033
- Status last verified
- Mar 2025
- First submitted
- 20 Nov 2023
- Last updated
- 19 Mar 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Zheng S, Xu Z, Wei Y, Zeng M, He J. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery--a meta-analysis. J Formos Med Assoc. 2013 Aug;112(8):463-72. doi: 10.1016/j.jfma.2012.03.003. Epub 2012 Sep 7.
PubMed 24016611Marusch F, Hussock J, Haring G, Hachenberg T, Gastinger I. Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery. Br J Anaesth. 2005 May;94(5):596-600. doi: 10.1093/bja/aei110. Epub 2005 Feb 25.
PubMed 15734779Combes X, Andriamifidy L, Dufresne E, Suen P, Sauvat S, Scherrer E, Feiss P, Marty J, Duvaldestin P. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007 Aug;99(2):276-81. doi: 10.1093/bja/aem147. Epub 2007 Jun 15.
PubMed 17573390Lu IC, Wu SH, Wu CW. Neuromuscular blockade management for intraoperative neural monitoring. Kaohsiung J Med Sci. 2020 Apr;36(4):230-235. doi: 10.1002/kjm2.12153. Epub 2019 Nov 12.
PubMed 31713975Grant S, Noble S, Woods A, Murdoch J, Davidson A. Assessment of intubating conditions in adults after induction with propofol and varying doses of remifentanil. Br J Anaesth. 1998 Oct;81(4):540-3. doi: 10.1093/bja/81.4.540.
PubMed 9924229
Study at a glance
From the registry record, last updated by the sponsor on 19 Mar 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimal Concentration of Remifentanil for Achieving Excellent Intubating Condition During Low-dose Neuromuscular Blocking Agent Administration for Intraoperative Neuromonitoring Using Nerve Integrity Monitoring Tube
- ClinicalTrials.gov ID
- NCT06162390
- Acronym / sponsor ID
- KNUCH 2023-10-033
- Conditions
- Thyroidectomy
- Keywords
- Intraoperative nerve monitoring, Neuromuscular blocking agents, Remifentanil
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 21 participants (actual)
- Lead sponsor
- Kyungpook National University Chilgok HospitalUniversity, hospital or other
- Study start
- 20 Nov 2023 (actual)
- Primary completion
- 10 Mar 2024 (actual)
- Study completion
- 20 Mar 2024 (actual)
- First posted
- 8 Dec 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
During thyroid surgery, Intraoperative Neuromonitoring (IONM) plays a crucial role in preventing serious complications such as bilateral vocal cord paralysis. It achieves this by detecting damage to the recurrent laryngeal nerve (RLN) and predicting the RLN's functional status. The utilization of Nerve Integrity Monitoring tubes (NIM tubes) is on the rise for effective IONM. As IONM relies on observing electromyographic (EMG) responses to direct electrical nerve stimulation, the routine use of neuromuscular blocking agents (NMBAs) in general anesthesia can impact the interpretation of IONM results and potentially reduce sensitivity to nerve responses to stimulation. However, the use of NMBAs is essential for ensuring smooth endotracheal intubation in patients undergoing general anesthesia. Numerous studies suggest that NMBA usage provides superior intubation conditions and reduces vocal cord complications compared to scenarios without NMBA.
Various regimens for neuromuscular blockade methods are employed during IONM in thyroid surgery, ranging from not using NMBAs at all to using a full dose of NMBA for intubation. This is followed by the administration of sugammadex, an NMBA reversal agent, before nerve monitoring. One of the methods known for providing satisfactory intubation conditions while ensuring the quality of EMG signals during IONM in thyroid surgery is using rocuronium at an ED95 dose of 0.3 mg/kg. This approach is considered suitable for most IONM scenarios. However, when adequate muscle relaxation is not achieved, not all patients can undergo intubation, necessitating a strategy for appropriate intubation conditions.
Historically, it has been reported that achieving satisfactory intubation conditions without the use of NMBA during general anesthesia requires higher amounts of propofol and opioids. Therefore, the assumption is made that using remifentanil, an opioid used in total intravenous anesthesia (TIVA), at an appropriate concentration can provide acceptable intubation conditions with minimal NMBA use for patients undergoing IONM.
This study aims to determine the optimal concentration of remifentanil needed to achieve excellent intubation conditions in patients undergoing thyroid surgery with IONM using rocuronium 0.3 mg/kg as the NMBA during TIVA
Study design
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Remifentanil for NIM tube intubation | Experimental | Drug: Remifentanil |
Who may qualify
- Ages
- 20 to 60 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- All female aged 20-60
- ASA (American Society of Anesthesiologists) physical status I or II
- who scheduled for thyroidectomy under intraoperative neuromonitoring with a nerve integrity monitoring tube (NIM tube)
Key exclusion criteria (6 listed)
- Patients anticipated to experience challenging intubation.
- Patients who have had an upper respiratory tract infection within the past 2 weeks.
- Patients with a history of heart, lung, and kidney diseases.
- Patients with a body mass index (BMI) of 30 kg/m² or higher.
- Patients currently taking analgesics.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| RemifentanilFollowing a sequential allocation scheme, the predetermined Ce of remifentanil for each patient will be determined by the Dixon up-and-down method. The Ce of remifentanil for the first patient will be 4.0 ng/ml, and then the remifentanil Ce will be increased or decreased in 0.5 ng/ml increments for subsequent patients depending on the success or failure of intubation. The Ce of remifentanil to provide acceptable intubation at low dose neuromuscular blockade, the primary outcome, will be determined by obtaining seven crossovers of patients with "acceptable intubation"/"unacceptable intubation" and then calculating the mean of the midpoint doses for each independent pair of patients. According to previous studies that estimated EC50 by Dixon's up-and-down method, 6-8 "failure/success crossover pairs" are required, so this study aims to collect independent data of 7 pairs of "intubation acceptable/unacceptable" patients. | Drug | Remifentanil for NIM tube intubation |
Primary outcome
Optimal effect-site concentration (Ce) of remifentanil
Time frame: During the tracheal intubation
Finding the Ce of remifentanil that provides acceptable condition of tracheal intubation when administering a low-dose NMBA is the aim of the study. The Ce of remifentanil for the first patient is 4.0 ng/ml, and then the Ce is increased or decreased in 0.5 ng/ml increments for subsequent patients depending on the success or failure of intubation. About 3 minutes after administering rocuronium 0.3 mg/kg, NIM tube will be intubated. At this time, the intubation condition will be evaluated using the grading system described by Fuchs-Buder. There are 4 items (jaw relaxation, vocal cord position, cough response, and limb movement) that are evaluated, and a total score can be calculated based on them: 1 point if all items are E, 3 points if even one item is P, and 2 points for the rest. A tracheal intubation condition rating of 1 or 2 indicates that the intubation is acceptable (successful), and a rating of 3 indicates that the intubation is unacceptable (unsuccessful).
4 secondary outcomes
The rating of each item of the grading system of the tracheal intubation condition
Time frame: During the tracheal intubation
Total dose of remifentanil administered until tracheal intubation
Time frame: From the start of the anesthesia induction to tracheal intubation
Incidence of hypotension and bradycardia
Time frame: From the start of the anesthesia induction to tracheal intubation
Doses of agents (ephedrine and atropine) administered to treat hypotension and bradycardia
Time frame: From the start of the anesthesia induction to tracheal intubation
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Mar 2025.
- Background: PubMed 24016611Zheng S, Xu Z, Wei Y, Zeng M, He J. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery--a meta-analysis. J Formos Med Assoc. 2013 Aug;112(8):463-72. doi: 10.1016/j.jfma.2012.03.003. Epub 2012 Sep 7.
- Background: PubMed 15734779Marusch F, Hussock J, Haring G, Hachenberg T, Gastinger I. Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery. Br J Anaesth. 2005 May;94(5):596-600. doi: 10.1093/bja/aei110. Epub 2005 Feb 25.
- Background: PubMed 17573390Combes X, Andriamifidy L, Dufresne E, Suen P, Sauvat S, Scherrer E, Feiss P, Marty J, Duvaldestin P. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007 Aug;99(2):276-81. doi: 10.1093/bja/aem147. Epub 2007 Jun 15.
- Background: PubMed 31713975Lu IC, Wu SH, Wu CW. Neuromuscular blockade management for intraoperative neural monitoring. Kaohsiung J Med Sci. 2020 Apr;36(4):230-235. doi: 10.1002/kjm2.12153. Epub 2019 Nov 12.
- Background: PubMed 9924229Grant S, Noble S, Woods A, Murdoch J, Davidson A. Assessment of intubating conditions in adults after induction with propofol and varying doses of remifentanil. Br J Anaesth. 1998 Oct;81(4):540-3. doi: 10.1093/bja/81.4.540.
- Individual participant dataSharing planned: No
Related trials for Thyroidectomy
Recruiting
NIRAF-Guided Parathyroid Identification During Thyroidectomy
Hypocalcemia, Hypoparathyroidism
Recruiting
Safety and Efficacy of NTP in Thyroid Surgery: Pilot Study on Morbidity Prevention and Adjuvant Oncological Control
Thyroid Diseases, Wound Healing
Recruiting
Comparison of Post-operative Outcomes Between ERAS Protocol and Non-ERAS Local Regimen in Patients Undergoing Thyroidectomy
Thyroid Diseases, Ambulation Time
Not yet recruitingObservational study
Serum Treg/Th17-Related Cytokines and Systemic Inflammatory Indices in Differentiated Thyroid Cancer
Differentiated Thyroid Cancer (DTC), Papillary Thyroid Carcinoma
RecruitingPhase 4
Remifentanil Versus Remifentanil-Lidocaine for Tracheal Extubation After Thyroidectomy
Tracheal Extubation, Cough
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Remifentanil in people with Thyroidectomy, run by Kyungpook National University Chilgok Hospital at 1 site in South Korea.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 19 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Optimal effect-site concentration (Ce) of remifentanil (time frame: During the tracheal intubation). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06162390, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Mar 2025.