Trial Outcomes & Findings for TOF Monitoring Using the TetraGraph in Patients Less Than 1 Year of Age (NCT NCT06458023)

NCT ID: NCT06458023

Last Updated: 2026-05-13

Results Overview

The Train of Four ratio (TOFr) is a quantitative measure used in anesthesia to assess the depth of neuromuscular blockade and recovery, calculated by dividing the amplitude of the fourth twitch by the first twitch after four 2-Hz stimuli. A TOF ratio is the standard threshold for safe extubation and indicates sufficient recovery from nondepolarizing agents. A TOF ratio \>/= 90% is the standard threshold for safe extubation and indicates sufficient recovery from nondepolarizing agents.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

50 participants

Primary outcome timeframe

During the surgery (1-3 hrs. avg.)

Results posted on

2026-05-13

Participant Flow

One subject was excluded from the study prior to the TetraGraph being placed because the surgeon decided a neuromuscular blocking agent was not required clinically to complete the surgery. All other subjects were placed in the TetraGraph group.

Participant milestones

Participant milestones
Measure
TetraGraph (TM) NMT Monitor
TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block. TetraGraph (TM) NMT Monitor: TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block.
Overall Study
STARTED
50
Overall Study
COMPLETED
49
Overall Study
NOT COMPLETED
1

Reasons for withdrawal

Reasons for withdrawal
Measure
TetraGraph (TM) NMT Monitor
TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block. TetraGraph (TM) NMT Monitor: TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block.
Overall Study
Patient didn't receive neuromuscular blocking agent
1

Baseline Characteristics

TOF Monitoring Using the TetraGraph in Patients Less Than 1 Year of Age

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
TetraGraph (TM) NMT Monitor
n=49 Participants
TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block. TetraGraph (TM) NMT Monitor: TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block.
Ethnicity (NIH/OMB)
Not Hispanic or Latino
44 Participants
n=1512 Participants
Age, Continuous
5.45 months
STANDARD_DEVIATION 2.67 • n=1512 Participants
Sex: Female, Male
Female
21 Participants
n=1512 Participants
Sex: Female, Male
Male
28 Participants
n=1512 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
4 Participants
n=1512 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants
n=1512 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=1512 Participants
Race (NIH/OMB)
Asian
0 Participants
n=1512 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=1512 Participants
Race (NIH/OMB)
Black or African American
4 Participants
n=1512 Participants
Race (NIH/OMB)
White
34 Participants
n=1512 Participants
Race (NIH/OMB)
More than one race
10 Participants
n=1512 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants
n=1512 Participants
Region of Enrollment
United States
49 participants
n=1512 Participants
Weight
3.1 kilograms
STANDARD_DEVIATION 1.83 • n=1512 Participants
Participants per weight group
0 to <4 kg
3 Participants
n=1512 Participants
Participants per weight group
4 to <6 kg
20 Participants
n=1512 Participants
Participants per weight group
6 to <8 kg
16 Participants
n=1512 Participants
Participants per weight group
More than 8 kg
10 Participants
n=1512 Participants

PRIMARY outcome

Timeframe: During the surgery (1-3 hrs. avg.)

The Train of Four ratio (TOFr) is a quantitative measure used in anesthesia to assess the depth of neuromuscular blockade and recovery, calculated by dividing the amplitude of the fourth twitch by the first twitch after four 2-Hz stimuli. A TOF ratio is the standard threshold for safe extubation and indicates sufficient recovery from nondepolarizing agents. A TOF ratio \>/= 90% is the standard threshold for safe extubation and indicates sufficient recovery from nondepolarizing agents.

Outcome measures

Outcome measures
Measure
TetraGraph (TM) NMT Monitor
n=49 Participants
TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block. TetraGraph (TM) NMT Monitor: TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block.
TOFr (%)
Baseline
99 percent
Standard Deviation 16.3
TOFr (%)
Recovered (after reversal of neuromuscular blockade)
95 percent
Standard Deviation 10

PRIMARY outcome

Timeframe: During the surgery (1-3 hrs. avg.)

The amplitude of the muscle action potential in response to electrical stimulation of its corresponding peripheral nerve.

Outcome measures

Outcome measures
Measure
TetraGraph (TM) NMT Monitor
n=49 Participants
TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block. TetraGraph (TM) NMT Monitor: TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block.
Amplitude
Baseline
6.8 millivolts
Standard Deviation 2.2
Amplitude
Recovered
4.7 millivolts
Standard Deviation 1.5

SECONDARY outcome

Timeframe: Baseline, After reversal of neuromuscular blockade during surgery (avg of 1-3 hrs)

The amount of time from administration of neuromuscular blockade reversal agent to muscle recovery (TOFr \>/= 90).

Outcome measures

Outcome measures
Measure
TetraGraph (TM) NMT Monitor
n=49 Participants
TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block. TetraGraph (TM) NMT Monitor: TetraGraph is a unique, EMG-based portable device for quantitative (objective) monitoring of neuromuscular function. It is a precise and easy to use tool for monitoring depth of block, ensuring adequate recovery of muscle function, and aiding the clinician to reduce the incidence of residual block.
Rate of Muscle Recovery
2.7 minutes
Standard Deviation 1.4

Adverse Events

TetraGraph (TM) NMT Monitor

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Joseph Tobias

Nationwide Children's Hospital

Phone: 614-722-4200

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place