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Effect of reversal of residual neuromuscular blockade on the amplitude of motor evoked potentials: a randomized controlled crossover study comparing sugammadex and placebo

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Abstract

Purpose

To compare the amplitude changes in motor evoked potentials (MEP) with reversal of residual neuromuscular blockade using sugammadex or placebo in patients with cervical myelopathy.

Methods

In this prospective randomized double-blind, placebo-controlled crossover trial, 38 patients with cervical myelopathy undergoing posterior cervical decompression and fusion were randomized to either sugammadex (2mg/kg) or placebo. The primary outcome measure was the increase in amplitude of the MEP in the first dorsal interossei (FDI) muscle at 3 min. Mann-Whitney U test was used to analyze the primary outcome measure.

Results

There was a significant increase in the amplitude of MEP at 3 min with sugammadex when compared to placebo group. The median (IQR) increase in MEP amplitude (μV) at 3 min from the left FDI in sugammadex and placebo group was 652.9 (142:1650) and 20.6 (−183.5:297.5) (p <0.001), respectively. Corresponding values from right FDI were 2153.4 (1400:4536.8) and 55(−65.2:480.8) (p=<0.001).

Conclusion

Our study showed that there was a 200% increase in the MEP amplitude in the first dorsal interosseous muscle at 3 min following reversal of residual neuromuscular blockade with sugammadex. By ensuring that maximal MEP amplitude is recorded at baseline, early commencement of neuromonitoring can be achieved.

Trial registration number and date of registration

The study was registered at http://clinicaltrials.gov, ID NCT03087513, Feb 5th 2018.

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Availability of data and material

Available at request

Code availability

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Acknowledgements

We are deeply grateful to Dr. Emad Al Azazi for his dedication and perseverance with the data collection for this manuscript and Kawalpreet Singh for his help with data analysis.

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Authors and Affiliations

  1. Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada

    Lashmi Venkatraghavan, Nathan Royan, Sarah L. Boyle, Michael Dinsmore & Atul Prabhu

  2. Department of Neurosurgical Intraoperative Monitoring, Division of Perioperative Surgical Services, Toronto Western Hospital, University Health Network, Toronto, Canada

    Nancy Lu & Kristina Cushman

  3. Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada

    Eric M. Massicotte

Authors
  1. Lashmi Venkatraghavan
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  2. Nathan Royan
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  3. Sarah L. Boyle
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  4. Michael Dinsmore
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  5. Nancy Lu
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  6. Kristina Cushman
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  7. Eric M. Massicotte
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  8. Atul Prabhu
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Contributions

L.V. helped with study design and literature review, writing the study protocol and data analysis, and writing the manuscript. N. R helped with study design, literature review, study protocol, and writing the manuscript. SB helped with the data collection and writing the manuscript. MD helped with the data collection, data analysis, and writing the manuscript. NL helped with the data collection and writing the manuscript. C. K helped with the data collection and writing the manuscript. EMM helped with the study design, data collection, and writing the manuscript. A. P helped with the study design, study protocol, and writing the manuscript.

Corresponding author

Correspondence to Lashmi Venkatraghavan.

Ethics declarations

Ethics approval

This study was approved by the Research Ethics board of University Health Network, Toronto (UHN REB#: 16-5926-B).

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Written informed consent was obtained from all patients.

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Obtained

Conflict of interest

None

Financial Support

This study was supported by the Supported in part by a research grant from Investigator-initiated program of Merck Canada Inc.

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Venkatraghavan, L., Royan, N., Boyle, S.L. et al. Effect of reversal of residual neuromuscular blockade on the amplitude of motor evoked potentials: a randomized controlled crossover study comparing sugammadex and placebo. Neurol Sci 43, 615–623 (2022). https://doi.org/10.1007/s10072-021-05318-8

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  • DOI: https://doi.org/10.1007/s10072-021-05318-8

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