Reversal of rocuronium‐induced neuromuscular blockade by sugammadex allows for optimization of neural monitoring of the recurrent laryngeal nerve

Lu, I‐Cheng; Wu, Che‐Wei; Chang, Po-Chun; Chen, Hsiu-Ya; Tseng, Kuang‐Yi; Randolph, Gregory W.; Cheng, Kuang‐I

doi:10.1002/lary.25577

Cited by 37 publications

(54 citation statements)

References 30 publications

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“…Furthermore, it was proved by several clinical studies in humans (5, 6). Lu et al (10) reported that 2 mg kg −1 of sugammadex usage is adequate for effective and rapid neuromuscular recovery. In the present study, we ensured a safe and rapid recovery profile using the same dose.…”

Section: Discussionmentioning

confidence: 99%

Effect of Smoking on Reversing Neuromuscular Block

Öztürk¹,

Sezen²,

Ankaralı³

et al. 2016

Turk J Anaesth Reanim

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Objective: Rocuronium is a non-depolarising, intermediate-acting, monoquaternary amino steroid and was brought into clinical use as a potentially ideal muscle relaxant. Post-operative residual curarisation (PORC) results from the prolonged effects of non-depolarising neuromuscular blocking agents. This is a common problem and seriously affects patient safety. No recent study has investigated the effects of sugammadex on smokers, which is often used to restore neuromuscular block and avoid PORC. This study compares the severity of the effects of sugammadex used for antagonising rocuronium bromide and antagonism durations in smokers and non-smokers.Methods: This randomised, prospective study included 40 patients scheduled for elective surgery and belonging to classes I and II based the American Society of Anesthesiologists classification, who were either smokers for at least 10 years or non-smokers. Patients underwent routine and neuromuscular monitoring. At induction, 2 mg kg −1 propofol and 1 mcg kg −1 intravenous fentanyl were applied. After the loss of eyelash reflex, 0.6 mg kg −1 intravenous rocuronium was administered. Patients were intubated at train of four (TOF) 2. Anaesthesia was continued with 50% O 2 +50% air and 2% sevoflurane. Rocuronium, 0.15 mg kg −1 , was administered at TOF 2 during the operation. At the end of the operation, 2 mg kg −1 sugammadex was administered. The times until TOF 0.7, 0.8 and 0.9 were recorded.Results: Intubation time was 132.8±46.4 s for smokers and 127.6±32.7 s for non-smokers. After sugammadex administration, the time to TOF 0.7 was 153.3±54.7 s in smokers and 125±67.2 s in non-smokers. The times were 178.4±58.8 and 146.6±72.6 s for TOF 0.8 and 200.8±55.8 s and 170.4±77.8 s for TOF 0.9 in smokers and non-smokers, respectively. Conclusion:Although not statistically significant, the time to reach each TOF was longer for smokers. Larger populations and different perspectives are needed to find if sugammadex use is affected by smoking, which has negative effects on the body. Keywords: General anaesthesia, sugammadex, smokingAmaç: Rokuronyum orta etki başlama süresine sahip, aminosteroid yapıda non depolarizan steroid kas gevşeticidir ve ideal kas gevşetici bulma çabaları sonucunda klinik amaçlı kullanılmaya başlanmıştır. Postoperatif kürarizasyon (PORC) non-depolarizan kas gevşeticilerin etkisinin uzaması sonucu ortaya çıkar. Bu önemli sorun günümüzde hala yaygındır ve hasta güvenliğini ciddi bir şekilde etkilemektedir. Literatür taramamızda sigara içiminin nöromuskuler bloğun etkisini ortadan kaldırmak ve PORC'dan kaçınmak için daha sık kıllanılan sugammadex üzerine etkisini araştıran bir çalışma bulunmamıştır. Bu çalışmanın amacı sigara kullanımının rokuronyum bromürü antagonize etmek için kullanılan sugammadexin etkinliği üzerine etkisini araştırmaktır.Yöntemler: Prospektif randomize çalışmaya ASA 1-2; son 10 yıl-dır sigara içen veya hiç içmeyen elektif cerrahi hazırlığı yapılan hastalar dahil edildi. Hastalara rutin vital bulgu monitorizasyonu ve nöromuskuler monitörizasy...

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Section: Discussionmentioning

confidence: 99%

Effect of Smoking on Reversing Neuromuscular Block

Öztürk¹,

Sezen²,

Ankaralı³

et al. 2016

Turk J Anaesth Reanim

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“…In addition, sugammadex can also be used at any stage of surgery to reverse deep neuromuscular block when IONM is necessary . However, the regimen (routine/selective) and even dose of sugammadex for neural monitoring remains debatable . Table summarized published sugammadex protocol in clinical scenario, target nerve, neuromonitoring technique, and outcomes.…”

Section: Neuromuscular Blocking Agent Regimensmentioning

confidence: 99%

“…49 In addition, sugammadex can also be used at any stage of surgery to reverse deep neuromuscular block when IONM is necessary. 35,50,51 However, the regimen (routine/selective) and even dose of sugammadex for neural monitoring remains debatable. 52,53 35,50,51,[54][55][56] A protocol of sugammadex 2 mg/kg at skin incision rapidly restores neuromuscular function suppressed by rocuronium 0.6 mg/ kg at anesthesia induction.…”

Section: Rocuronium Combined With Sugammadexmentioning

confidence: 99%

“…35,50,51 However, the regimen (routine/selective) and even dose of sugammadex for neural monitoring remains debatable. 52,53 35,50,51,[54][55][56] A protocol of sugammadex 2 mg/kg at skin incision rapidly restores neuromuscular function suppressed by rocuronium 0.6 mg/ kg at anesthesia induction. All patients receiving routine regimen showed high initial EMG amplitude at initial vagal (V1) stimulation, which was vital for surgical decision and nerve injury evaluation during monitored thyroidectomy.…”

Section: Rocuronium Combined With Sugammadexmentioning

confidence: 99%

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Neuromuscular blockade management for intraoperative neural monitoring

2019

The Kaohsiung J of Med Scie

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This article reviews the literature on development of neuromuscular blockade management in thyroid surgery with intraoperative neural monitoring (IONM) in the past decade. Neuromuscular blockade management includes the choice of neuromuscular blocking agents (NMBAs) and reversal of neuromuscular blockade by sugammadex. A series of animal study and clinical trials showed NMBAs effect on IONM in thyroid surgery. We summarized five NMBA regimens for IONM: (a) relaxant‐free regimen, (b) depolarizing NMBA‐succinylcholine, (c) titration of nondepolarizing NMBA, and (d) rocuronium combined with sugammadex. The proper management of neuromuscular blockade during IONM has greatly developed over the past decade. The misuse of NMBAs is associated with false IONM interpretations to surgeons. A detailed understanding of NMBAs and neuromuscular blockade management by sugammadex may optimize IONM quality in patients receiving monitored thyroid surgery.

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Dear Editor:We read with interest the study by Lu et al about routine sugammadex reversal in patients with rocuroniuminduced neuromuscular blockade undergoing thyroidectomy. 1 This study showed that after a single intubating dose of rocuronium, sugammadex 2 mg/kg was effective to restore sufficient neuromuscular function, allowing intraoperative neuromonitoring (IONM). Also, this article concluded that implementation of this enhanced neuromuscular blockade recovery protocol would assure optimal conditions for both tracheal intubation and subsequent IONM during thyroid surgery.

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mentioning

confidence: 98%