Recurrent Laryngeal Nerve Monitoring and Rocuronium: A Selective Sugammadex Reversal Protocol
- 350 Downloads
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.
KeywordsRecurrent Laryngeal Nerve Rocuronium Neuromuscular Blockade Neuromuscular Block Ideal Body Weight
This work was funded only by departmental resources.
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.
- 13.Lundstrøm LH, Møller AM, Rosenstock C et al (2009) Avoidance of neuromuscular blocking agents may increase the risk of difficult tracheal intubation: a cohort study of 103,812 consecutive adult patients recorded in the Danish Anaesthesia Database. Br J Anaesth 103:283–290. doi: 10.1093/bja/aep124 CrossRefPubMedGoogle Scholar