World Journal of Surgery

, Volume 41, Issue 9, pp 2298–2303 | Cite as

Recurrent Laryngeal Nerve Monitoring and Rocuronium: A Selective Sugammadex Reversal Protocol

  • Ombeline Empis de VendinEmail author
  • Denis Schmartz
  • Laurent Brunaud
  • Thomas Fuchs-Buder
Original Scientific Report



The use of neuromuscular blocking agents may affect intraoperative neuromonitoring during thyroid surgery. A selective neuromuscular recovery protocol was evaluated in a retrospective cohort study during human thyroid neural monitoring surgery.


One hundred and twenty-five consecutive patients undergoing thyroidectomy with intraoperative neuromonitoring followed a selective neuromuscular block recovery protocol—single intubating dose of rocuronium followed by sugammadex if needed at the first vagal stimulation (V1).


Data from 120 of 125 patients could be analysed. Fifteen (12.5%) patients needed sugammadex reversal to obtain an EMG response at the first vagal stimulation (V1). In the remaining 105 patients, spontaneous recovery of rocuronium-induced neuromuscular block was sufficient for a successful first vagal stimulation (V1).


In patients undergoing thyroid surgery, routine reversal of rocuronium block with sugammadex is not mandatory for reliable intraoperative neuromonitoring. A selective neuromuscular block recovery approach may be a valuable and more cost-efficient alternative to routine reversal.


Recurrent Laryngeal Nerve Rocuronium Neuromuscular Blockade Neuromuscular Block Ideal Body Weight 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was funded only by departmental resources.

Authors’ contributions

Denis Schmartz, Laurent Brunaud and Thomas Fuchs-Buder conceived and designed the study; Ombeline Empis de Vendin and Laurent Brunaud acquired the data; Ombeline Empis de Vendin, Denis Schmartz, Laurent Brunaud and Thomas Fuchs-Buder analysed and interpreted the data; Ombeline Empis de Vendin, Denis Schmartz, Laurent Brunaud and Thomas Fuchs-Buder drafted the manuscript; Ombeline Empis de Vendin, Denis Schmartz, Laurent Brunaud and Thomas Fuchs-Buder critically revised the manuscript.

Compliance with ethical standards

Conflict of interest

Ombeline Empis de Vendin, Denis Schmartz and Laurent Brunaud declare no conflict of interest. Thomas Fuchs-Buder received lecture honoraria from MSD, France.


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Ombeline Empis de Vendin
    • 1
    • 3
    Email author
  • Denis Schmartz
    • 1
    • 3
  • Laurent Brunaud
    • 2
    • 3
  • Thomas Fuchs-Buder
    • 1
    • 3
  1. 1.Department of Anesthesiology and Intensive Care MedicineCHRU de NancyVandoeuvre-lès-NancyFrance
  2. 2.Department of Digestive, Hepato-Biliary and Endocrine SurgeryCHRU de NancyVandoeuvre-lès-NancyFrance
  3. 3.Faculté de MédecineUniversité de LorraineVandoeuvre-lès-NancyFrance

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