Quantitative Versus qUAlitative NeuromoniToring of neUroMuscular Block for Non-cardiothoracic Surgery
Quantitative Versus qUAlitative NeuromoniToring of neUroMuscular Block for Non-cardiothoracic Surgery (The QUANTUM Trial): Single-center Cluster Randomized Multiple Crossover Trial
The University of Texas Health Science Center, Houston
1,032 participants
Sep 22, 2025
INTERVENTIONAL
Conditions
Summary
The purpose of this study is to assess the effect of quantitative block monitoring versus less expensive qualitative monitoring treatment effects on the lowest SpO2/FiO2 ratio in the PACU. The results will be incorporated into an enhanced recovery pathway for surgical patients.
Eligibility
Inclusion Criteria3
- Patient age ≥ 18 years old;
- General anesthesia with endotracheal intubation;
- Neuromuscular block with rocuronium.
Exclusion Criteria8
- Intubation before induction of anesthesia;
- Critically ill patients admitted from the ICU;
- Emergency cases;
- Non-intubated patients;
- Patients who will not be paralyzed through the surgery (spine).
- Patients with an implanted electronic device (e.g. cardiac pacemaker)
- Patients with allergies to adhesive
- Patients with pre-existing neuromuscular disease (e.g. Myasthenia Gravis)
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Interventions
The TetraGraph TOF monitor will be used to quantitatively assess the TOF-ratio. Quantitative monitoring includes objective measurement of the TOF-ratio, as defined by the ratio between the first and the fourth muscular responses and is quantified by acceleromyography. A TOF twitch response ratio equal or greater to 95% (TOF0.95) will be targeted prior to extubation. If TOF0.95 is not reached within 10 min of administering the initial dose of the respective reversal agent, redosing is recommended.
Clinicians will assess the TOF-ratio. Qualitative monitoring includes subjective assessment of the count and the amplitude of the muscular responses related to neuromuscular block depth. A TOF twitch response count of 4 similarly strong twitches will be targeted prior to extubation. If 4 similarly strong TOF twitch responses are not reached within 10 min of administering the initial dose of the respective reversal agent, redosing is recommended.
Locations(1)
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NCT07084363