The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

Abstract

The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery. Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25). Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%). In group S, rapid reverse of NMB was found and the twitch (%) recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery.

Precision Neuromuscular Block Management for Neural Monitoring During Thyroid Surgery

“…During monitored parotid or thyroid surgery, a dose of 2 mg/kg sugammadex could induce nearly complete NMB recovery within 10 minutes. 17,19 Since muscle relaxation is also required during surgery, complete neuromuscular function recovery may not be the best management protocol. The main purpose of this study was to investigate suitable dosage and timing of sugammadex administration.…”

“…Sugammadex as an antagonist to steroidal NMBA is applied in patients requiring IONM during thyroid or parotid surgery. [17][18][19] There is a controversy between routine and selective reversal of NMB with sugammadex in monitored thyroidectomy. In our previous study, we confirmed a routine fully-NMB-reversal protocol with sugammadex (2 mg/kg) provided both excellent intubation condition and high initial EMG signal of IONM in 100% of 50 patients.…”

Advantages and pitfalls of clinical application of sugammadex

“…These days, many surgical procedures require intraoperative neuromonitoring using a neural integrity monitor. In the case of ear, nose, and throat surgery, facial or recurrent laryngeal nerve monitoring is required for NMB reversal and sugammadex can be an option for the rapid and effective reversal from rocuronium-induced deep NMB [ 98 – 100 ].…”

Neuromuscular blockade management for intraoperative neural monitoring

“…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.…”

“…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.…”