Comparing the effect between continuous infusion and intermittent bolus of rocuronium for intraoperative neurophysiologic monitoring of neurointervention under general anesthesia

Abstract

Background:Medical researchers have been reluctant to use neuromuscular blocking drugs (NMBD) during the use of intraoperative motor evoked potential (MEP) monitoring despite the possibility of patient movement. In this study, we compared the effects of no NMBD and continuous rocuronium infusion on the incidence of patient involuntary movement and MEP monitoring.Methods:In this study, 80 patients who underwent neuro intervention with MEP monitoring were randomly assigned into 2 groups. After an anesthetic induction, bolus of rocuronium 0.1 mg/kg was injected when it was needed (for patient involuntary movement or at the request of the surgeon) in group B, and 5 mcg/kg/min of rocuronium were infused in group I study participants. The incidence of patient involuntary movement and spontaneous respiration, the mean MEP amplitude, coefficient of variation (CV), the incidence of MEP stimulus change and train-of-four (TOF) count were compared.Results:The incidence of involuntary movement and spontaneous movement were measured as significantly lower in group I (P < .05). The incidence of undetectable MEP did not differ as measured in both groups. The means and CVs of MEP amplitude in all limbs were significantly lower in group I. The mean TOF counts from 30 to 80 min of operation were significantly higher in group B.Conclusion:We conclude that the continuous infusion of rocuronium effectively inhibited the involuntary movement and spontaneous respiration of the patient while enabling MEP monitoring.

Total Intravenous Anesthesia Protocol for Decreasing Unacceptable Movements during Cerebral Aneurysm Clipping with Motor-Evoked Potential Monitoring: A Historical Control Study and Meta-Analysis

“…In their study, no spontaneous movement or spontaneous breathing events were reported in any of the 276 patients who underwent aneurysm clipping with no NMB. In the study by Ko et al [ 19 ], propofol (effect-site concentration, 2–5 μg/mL) and remifentanil (2–4 ng/mL) were infused via a TCI pump for anesthesia maintenance. The incidence of spontaneous movement and respiration was 30.0% (12/40) and 15.0% (6/40), respectively.…”

“… Forest plot of intraoperative spontaneous movement during motor-evoked potential monitoring in patients undergoing neurosurgery. CI, confidence interval, [ 10 , 12 , 13 , 17 , 19 , 20 ]. …”

Effects of rocuronium dosage on intraoperative neurophysiological monitoring in patients undergoing spinal surgery

“…Some studies have shown that partial neuromuscular blockade can provide the right monitoring conditions for neurophysiological monitoring and improve the safety of anaesthesia and surgery. 11 , 12 Although the existing research results have shown the relationship between the degree of muscle relaxation and MEP amplitudes, most of the clinical anaesthesia in China does not have the requirement of monitoring the degree of muscle relaxation. Therefore, the purpose of this study was to identify an optimal muscle relaxant dose to provide useful reference information for spinal surgery.…”

“…According to Ko et al, continuous infusion of rocuronium effectively inhibited unexpected intraoperative body movement and spontaneous breathing of the patient while enabling MEP monitoring. 12 Therefore, it is essential to identify an appropriate maintenance dose of a muscle relaxant that ensures smooth progression of the operation without interfering with neurophysiological monitoring for spinal surgery.…”

A study on the appropriate dose of rocuronium for intraoperative neuromonitoring in Da Vinci robot thyroid surgery: a randomized, double-blind, controlled trial

“…The ideal muscle relaxation for robotic thyroid surgery should meet the requirements of surgical operation, avoid affecting the operation, and not interfere with IONM. Studies have shown that appropriate neuromuscular blockade can provide appropriate neurophysiological monitoring conditions and improve the safety of anesthesia and surgery ( 24 , 31 ). This indicates that our experiment has clinical significance.…”