Skip to main content
SpringerLink
Log in

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

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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).

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Combes X, Andriamifidy L, Dufresne E et al (2007) Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth 99:276–281. doi:10.1093/bja/aem147

    Article  CAS  PubMed  Google Scholar 

  2. Marusch F, Hussock J, Haring G et al (2005) Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery. Br J Anaesth 94:596–600. doi:10.1093/bja/aei110

    Article  CAS  PubMed  Google Scholar 

  3. Dralle H, Sekulla C, Lorenz K et al (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32:1358–1366. doi:10.1007/s00268-008-9483-2

    Article  CAS  PubMed  Google Scholar 

  4. Wu C-W, Wang M-H, Chen C-C et al (2015) Loss of signal in recurrent nerve neuromonitoring: causes and management. Gland Surg 4:19–26. doi:10.3978/j.issn.2227-684X.2014.12.03

    PubMed  PubMed Central  Google Scholar 

  5. Lu I-C, Wu C-W, Chang P-Y et al (2016) Reversal of rocuronium-induced neuromuscular blockade by sugammadex allows for optimization of neural monitoring of the recurrent laryngeal nerve. Laryngoscope 126:1014–1019. doi:10.1002/lary.25577

    Article  CAS  PubMed  Google Scholar 

  6. Brunaud L, Fuchs-Buder T (2016) In response to Reversal of rocuronium-induced neuromuscular blockade by sugammadex allows for optimization of neural monitoring of the recurrent laryngeal nerve. Laryngoscope. doi:10.1002/lary.25990

    PubMed  Google Scholar 

  7. Fuchs-Buder T, Claudius C, Skovgaard LT et al (2007) Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand 51:789–808. doi:10.1111/j.1399-6576.2007.01352.x

    Article  CAS  PubMed  Google Scholar 

  8. Blobner M, Eriksson LI, Scholz J et al (2010) Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesthesiol 27(10):874–881

    Article  CAS  PubMed  Google Scholar 

  9. Meyhoff CS, Lund J, Jenstrup MT et al (2009) Should dosing of rocuronium in obese patients be based on ideal or corrected body weight? Anesth Analg 109:787–792. doi:10.1213/ane.0b013e3181b0826a

    Article  CAS  PubMed  Google Scholar 

  10. Fontenot TE, Randolph GW, Setton TE et al (2015) Does intraoperative nerve monitoring reliably aid in staging of total thyroidectomies? Laryngoscope 125:2232–2235. doi:10.1002/lary.25133

    Article  PubMed  Google Scholar 

  11. Lu I-C, Chu K-S, Tsai C-J et al (2008) Optimal depth of NIM EMG endotracheal tube for intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroidectomy. World J Surg 32:1935–1939. doi:10.1007/s00268-008-9549-1

    Article  PubMed  Google Scholar 

  12. Lu I-C, Tsai C-J, Wu C-W et al (2011) A comparative study between 1 and 2 effective doses of rocuronium for intraoperative neuromonitoring during thyroid surgery. Surgery 149:543–548. doi:10.1016/j.surg.2010.11.006

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  14. Mencke T, Echternach M, Kleinschmidt S et al (2003) Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 98:1049–1056

    Article  CAS  PubMed  Google Scholar 

  15. Dell-Kuster S, Levano S, Burkhart CS et al (2015) Predictors of the variability in neuromuscular block duration following succinylcholine: a prospective, observational study. Eur J Anaesthesiol 32:687–696. doi:10.1097/EJA.0000000000000308

    Article  CAS  PubMed  Google Scholar 

  16. Schreiber J-U, Lysakowski C, Fuchs-Buder T, Tramèr MR (2005) Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials. Anesthesiology 103:877–884

    Article  CAS  PubMed  Google Scholar 

  17. Fuchs-Buder T, Schmartz D (2016) The never ending story or the search for a nondepolarising alternative to succinylcholine. Eur J Anaesthesiol 30:583–584. doi:10.1097/EJA.0b013e32836315c3

    Article  Google Scholar 

  18. Fuchs-Buder T, Meistelman C, Raft J (2013) Sugammadex: clinical development and practical use. Korean J Anesthesiol 65:495–500. doi:10.4097/kjae.2013.65.6.495

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Esteves S (2015) Can residual paralysis be avoided?: A critical appraisal of the use of sugammadex. Eur J Anaesthesiol 32:663–665. doi:10.1097/EJA.0000000000000294

    Article  PubMed  Google Scholar 

  20. Fuchs-Buder T, Schreiber J-U, Meistelman C (2009) Monitoring neuromuscular block: an update. Anaesthesia 64(Suppl 1):82–89. doi:10.1111/j.1365-2044.2008.05874.x

    Article  PubMed  Google Scholar 

  21. Meistelman C, Plaud B, Donati F (1992) Rocuronium (ORG 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans. Can J Anaesth (J Can d’anesthésie) 39:665–669. doi:10.1007/BF03008227

    Article  CAS  Google Scholar 

  22. Schlaich N, Mertzlufft F, Soltész S, Fuchs-Buder T (2000) Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia. Acta Anaesthesiol Scand 44:720–726

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

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.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, CHRU de Nancy, Vandoeuvre-lès-Nancy, France

    Ombeline Empis de Vendin, Denis Schmartz & Thomas Fuchs-Buder

  2. Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHRU de Nancy, Vandoeuvre-lès-Nancy, France

    Laurent Brunaud

  3. Faculté de Médecine, Université de Lorraine, Vandoeuvre-lès-Nancy, France

    Ombeline Empis de Vendin, Denis Schmartz, Laurent Brunaud & Thomas Fuchs-Buder

Authors
  1. Ombeline Empis de Vendin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Denis Schmartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laurent Brunaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Fuchs-Buder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ombeline Empis de Vendin.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Empis de Vendin, O., Schmartz, D., Brunaud, L. et al. Recurrent Laryngeal Nerve Monitoring and Rocuronium: A Selective Sugammadex Reversal Protocol. World J Surg 41, 2298–2303 (2017). https://doi.org/10.1007/s00268-017-4004-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4004-9

Keywords

Search

Navigation