Recovery of Laryngeal Nerve Function With Sugammadex After Rocuronium-Induced Profound Neuromuscular Block
| Autor: | Giuseppe De Scisciolo, Gabriele Gori, Lara Gianesello, Cristiana Martinelli, Alessandra Nella, Vittorio Pavoni, Martina Simonelli, Andrew Horton |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Larynx
Adult Male medicine.medical_specialty Adolescent Postoperative residual curarization Sugammadex 03 medical and health sciences Young Adult 0302 clinical medicine 030202 anesthesiology medicine Humans Androstanols Prospective Studies Rocuronium Ulnar nerve Monitoring Physiologic Postoperative Care business.industry Myography Laryngeal Nerves 030208 emergency & critical care medicine Recovery of Function Middle Aged medicine.disease Evoked Potentials Motor Adductor pollicis muscle Surgery Vocal muscle Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia Laryngeal Muscle Anesthesia Recovery Period Neuromuscular Blockade Female Neuromuscular Monitoring business medicine.drug Neuromuscular Nondepolarizing Agents gamma-Cyclodextrins |
| Zdroj: | Survey of Anesthesiology. 61:20 |
| ISSN: | 0039-6206 |
| DOI: | 10.1097/sa.0000000000000288 |
| Popis: | Study Objective The aim of this study was to evaluate the efficacy of sugammadex in reversing profound rocuronium-induced neuromuscular block at the laryngeal adductor muscles using motor-evoked potentials (mMEPs). Design A prospective observational study. Setting University surgical center. Patients Twenty patients with American Society of Anesthesiologists physical class I-II status who underwent propofol-remifentanil anesthesia for the surgery of the thyroid gland. Interventions Patients were enrolled for reversal of profound neuromuscular block (sugammadex 16 mg/kg, 3 minutes after rocuronium 1.2 mg/kg). To prevent laryngeal nerve injury during the surgical procedures, all patients underwent neurophysiologic monitoring using mMEPs from vocal muscles. At the same time, the registration of TOF-Watch acceleromyograph at the adductor pollicis muscle response to ulnar nerve stimulation was performed; recovery was defined as a train-of-four (TOF) ratio ≥ 0.9. Measurement and main results After injection of 16 mg/kg of sugammadex, the mean time to recovery of the basal mMEPs response at the laryngeal adductor muscles was 70 ± 18.2 seconds. The mean time to recovery of the TOF ratio to 0.9 was 118 ± 80 seconds. In the postoperative period, 12 patients received follow-up evaluation of the vocal cords and no lesions caused by the surface laryngeal electrode during electrophysiological monitoring were noted. Conclusions Recovery from profound rocuronium-induced block on the larynx is fast and complete with sugammadex. In urgent scenarios, “early” extubation can be performed, even with a TOF ratio ≤ 0.9. However, all procedures to prevent postoperative residual curarization should still be immediately undertaken. |
| Databáze: | OpenAIRE |
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