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

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 consecut...

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Bibliographic Details
Published in:World journal of surgery 2017-09, Vol.41 (9), p.2298-2303
Main Authors: Empis de Vendin, Ombeline, Schmartz, Denis, Brunaud, Laurent, Fuchs-Buder, Thomas
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Aged
Androstanols
Antidotes - therapeutic use
Blocking
Cardiac Surgery
Electromyography
Female
gamma-Cyclodextrins - therapeutic use
General Surgery
Humans
Ideal Body Weight
Male
Medicine
Medicine & Public Health
Middle Aged
Monitoring
Monitoring, Intraoperative
Neuromuscular Block
Neuromuscular Blockade
Neuromuscular Blockade - methods
Neuromuscular Nondepolarizing Agents
Original Scientific Report
Patients
Recovery
Recovery of Function - drug effects
Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve - physiopathology
Retrospective Studies
Rocuronium
Spontaneous recovery
Stimulation
Surgery
Thoracic Surgery
Thyroid
Thyroid gland
Thyroidectomy
Vagus nerve
Vascular Surgery
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Summary: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.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-017-4004-9