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Reversal of rocuronium‐induced neuromuscular blockade by sugammadex allows for optimization of neural monitoring of the recurrent laryngeal nerve
Author(s) -
Lu ICheng,
Wu CheWei,
Chang PiYing,
Chen HsiuYa,
Tseng KuangYi,
Randolph Gregory W.,
Cheng KuangI,
Chiang FengYu
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25577
Subject(s) - sugammadex , rocuronium , medicine , anesthesia , neuromuscular blockade , neuromuscular monitoring , saline , neuromuscular transmission , intubation , electromyography , surgery , psychiatry
Objectives/Hypothesis The use of neuromuscular blocking agent may effect intraoperative neuromonitoring (IONM) during thyroid surgery. An enhanced neuromuscular‐blockade (NMB) recovery protocol was investigated in a porcine model and subsequently clinically applied during human thyroid neural monitoring surgery. Study Design Prospective animal and retrospective clinical study. Methods In the animal experiment, 12 piglets were injected with rocuronium 0.6 mg/kg and randomly allocated to receive normal saline, sugammadex 2 mg/kg, or sugammadex 4 mg/kg to compare the recovery of laryngeal electromyography (EMG). In a subsequent clinical application study, 50 patients who underwent thyroidectomy with IONM followed an enhanced NMB recovery protocol—rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at the operation start. The train‐of‐four (TOF) ratio was used for continuous quantitative monitoring of neuromuscular transmission. Results In our porcine model, it took 49 ± 15, 13.2 ± 5.6, and 4.2 ± 1.5 minutes for the 80% recovery of laryngeal EMG after injection of saline, sugammadex 2 mg/kg, and sugammadex 4 mg/kg, respectively. In subsequent clinical human application, the TOF ratio recovered from 0 to >0.9 within 5 minutes after administration of sugammadex 2 mg/kg at the operation start. All patients had positive and high EMG amplitude at the early stage of the operation, and intubation was without difficulty in 96% of patients. Conclusions Both porcine modeling and clinical human application demonstrated that sugammadex 2 mg/kg allows effective and rapid restoration of neuromuscular function suppressed by rocuronium. Implementation of this enhanced NMB recovery protocol assures optimal conditions for tracheal intubation as well as IONM in thyroid surgery. Level of Evidence NA Laryngoscope , 126:1014–1019, 2016