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World J Surg. 2017 Sep;41(9):2298-2303. doi: 10.1007/s00268-017-4004-9.

Recurrent Laryngeal Nerve Monitoring and Rocuronium: A Selective Sugammadex Reversal Protocol.

Author information

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.

PMID:
28349321
DOI:
10.1007/s00268-017-4004-9
[Indexed for MEDLINE]

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