Ombeline Empis de Vendin1,2, Denis Schmartz3,4, Laurent Brunaud5,4, Thomas Fuchs-Buder3,4. 1. Department of Anesthesiology and Intensive Care Medicine, CHRU de Nancy, Vandoeuvre-lès-Nancy, France. ombelineempisdevendin@hotmail.fr. 2. Faculté de Médecine, Université de Lorraine, Vandoeuvre-lès-Nancy, France. ombelineempisdevendin@hotmail.fr. 3. Department of Anesthesiology and Intensive Care Medicine, CHRU de Nancy, Vandoeuvre-lès-Nancy, France. 4. Faculté de Médecine, Université de Lorraine, Vandoeuvre-lès-Nancy, France. 5. Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.
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 neuromonitoring 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.
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 neuromonitoring 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.
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