Effect of intraoperative neuromonitoring on efficacy and safety using sugammadex in thyroid surgery: randomized clinical trial

Mehmet Emin Gunes; Ahmet Cem Dural; Cevher Akarsu; Deniz Guzey; Nuri Alper Sahbaz; Evrim Kucur Tulubas; Sezer Bulut; Turgut Donmez

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저자정보: Mehmet Emin Gunes (Bakırköy Dr.Sadi Konuk Training and Research Hospital) Ahmet Cem Dural (Bakırköy Dr.Sadi Konuk Training and Research Hospital) Cevher Akarsu (Bakırköy Dr.Sadi Konuk Training and Research Hospital) Deniz Guzey (Bakırköy Dr.Sadi Konuk Training and Research Hospital) Nuri Alper Sahbaz (Bakırköy Dr.Sadi Konuk Training and Research Hospital) Evrim Kucur Tulubas (Bakırköy Dr.Sadi Konuk Training and Research Hospital) Sezer Bulut (Bakırköy Dr.Sadi Konuk Training and Research Hospital) Turgut Donmez (Bakırköy Dr.Sadi Konuk Training and Research Hospital)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.97 No.6

발행연도: 2019.12

수록면: 282 - 290 (9page)

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Purpose: The use of nondepolarizing neuromuscular blocking agents (NMBAs) may affect intraoperative neuromonitoring (IONM) during anesthesia used during thyroid and parathyroid surgery.
Methods: The use of sugammadex was evaluated in a prospective clinical study during thyroid surgery. Between July 2018 and January 2019, 129 patients were prospectively randomized to either the sugammadex group (group B) or the control group (group A). Group A patients underwent standardized IONM during thyroidectomy, while group B patients used an NMBA-reversal protocol comprised of rocuronium (0.6 mg/kg) in anesthesia induction and sugammadex (2 mg/kg) after first vagal stimulation (V0). A peripheral nerve stimulator was used to monitor the neuromuscular transmission.
Results: In our clinical study, it took 26.07 ± 3.26 and 50.0 ± 8.46 minutes to reach 100% recovery of laryngeal electromyography at injection of the sugammadex group (2 mg/kg) and the control group, respectively (P < 0.001). The train-of-four ratio recovered from 0 to >0.9 within 4 minutes after administering 2 mg/kg of sugammadex at the beginning of resection. Surgery time was significantly shorter in group B than in group A (P < 0.001). Transient recurrent laryngeal nerve (RLN) paralysis was detected in 4 patients from group A and in 3 patients from group B (P = 0.681). There was no permanent RLN paralysis in the 2 groups.
Conclusion: Our clinical study showed that sugammadex effectively and rapidly improved the inhibition of neuromuscular function induced by rocuronium. The implementation of the nondepolarizing neuromuscular block recovery protocol may lead to tracheal intubation as well as favorable conditions for IONM in thyroid surgery.

#Neuromuscular blockade #Recurrent laryngeal nerve #Sugammadex #Thyroidectomy

참고문헌 (30)

참고문헌 신청

Steurer M / 2002 / Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk / Laryngoscope 112:124~133

Dionigi G / 2010 / Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation : to the editor / World J Surg 34:2794~2795

Dralle H / 2008 / Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery / World J Surg 32:1358~1366

김수진 / 2015 / Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during robotic thyroid surgery: a preliminary prospective study / 대한외과학회지 89(5):233~239

Barczynski M / 2009 / Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy / Br J Surg 96:240~246

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