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

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 consecutive patients undergoing thyroidectomy with intraoperative neu- romonitoring 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. Introduction There is a controversy in the literature whether neuro- muscular blocking agents should be used to facilitate endotracheal intubation in patients undergoing thyroid & Ombeline Empis de Vendin surgery and requiring intraoperative neuromonitoring of ombelineempisdevendin@hotmail.fr the recurrent laryngeal nerve. Whilst NMBAs facilitate Denis Schmartz endotracheal intubation and http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png World Journal of Surgery Springer Journals

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

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Publisher
Springer International Publishing
Copyright
Copyright © 2017 by Société Internationale de Chirurgie
Subject
Medicine & Public Health; Surgery; Abdominal Surgery; Cardiac Surgery; General Surgery; Thoracic Surgery; Vascular Surgery
ISSN
0364-2313
eISSN
1432-2323
D.O.I.
10.1007/s00268-017-4004-9
Publisher site
See Article on Publisher Site

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 neu- romonitoring 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. Introduction There is a controversy in the literature whether neuro- muscular blocking agents should be used to facilitate endotracheal intubation in patients undergoing thyroid & Ombeline Empis de Vendin surgery and requiring intraoperative neuromonitoring of ombelineempisdevendin@hotmail.fr the recurrent laryngeal nerve. Whilst NMBAs facilitate Denis Schmartz endotracheal intubation and

Journal

World Journal of SurgerySpringer Journals

Published: Mar 27, 2017

References

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