Sugammadex and neostigmine: when better may not be best

Sidebotham, David; Frampton, Chris

doi:10.1111/anae.15961

Cited by 1 publication

(1 citation statement)

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“…Muscle relaxants and rNMB can elevate the risk of airway management and affect patient movements, thus precluding their use in awake anesthesia. [ 20 ] Moreover, electro-neurophysiological procedures, such as direct electronical stimulation, electrocorticography (ECoG), somatosensory evoked potentials (SSEP), and motor evoked potentials (MEP), are also affected by muscle relaxants and rNMB. Thus, most anesthesiologists avoid using muscle relaxants during ACs or short-acting agents during the induction period.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of using a combination of rocuronium and sugammadex for awake craniotomy anesthesia: A randomized clinical trial

Chen,

Yang,

Sun

et al. 2024

Medicine

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Background: Awake craniotomy (AC) is a neurosurgical method for the resection of brain lesions located in eloquent areas to achieve maximal and safe resection. A patient’s arousal quality is essential for the success of the operation. This study compared the arousal time and quality after AC achieved by 2 different drug combinations: rocuronium with sugammadex and propofol with remifentanil. Methods: This prospective, randomized, controlled trial included 42 adult patients undergoing AC with a laryngeal mask, who were randomly assigned to either a rocuronium-sugammadex group (RS; n = 21) or a propofol-remifentanil without muscle relaxant group (nRS; n = 21). The primary outcomes were the arousal time and arousal quality. The secondary outcomes included the number of laryngeal mask airway (LMA) adjustments and diaphragmatic excursion length. Results: This study included 42 participants. The median (IQR) arousal time was 13.5 minutes (7–20) in the RS group and 21 minutes (16.5–26.5) in the nRS group (P = .005). There was no significant difference in arousal quality between the 2 groups (P = .229). LMA adjustments were significantly less frequent in the nRS group than in the RS group [0.25 times (±0.62) vs 1.26 times (±1.17), P = .001]. Adverse events, such as spontaneous movements and brain swelling, were more frequent in the nRS group than in the RS group. Conclusions: Using a combination of rocuronium and sugammadex with propofol and remifentanil may shorten the awakening time, reduce the duration of laryngeal mask adjustment, and do not affect the arousal quality and postoperative outcomes for patients undergoing awake craniotomy, compared to propofol and remifentanil alone.

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Section: Discussionmentioning

confidence: 99%