Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2013 Sep;29(9):484-7. doi: 10.1016/j.kjms.2013.01.002. Epub 2013 Apr 6.
The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs). Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG) signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals) the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg), low-dose rocuronium (0.3 mg/kg), and standard dose rocuronium (0.6 mg/kg). The maximal neuromuscular blockade and 80% recovery (i.e., duration) of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg) was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg), 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg), 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had significantly shorter durations than standard dose rocuronium (0.6 mg/kg). The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg) group. In this study, succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery.
在甲状腺手术中，使用琥珀酰胆碱和罗库溴铵进行术中神经监测（IONM）据报道是可行的。本研究旨在调查和比较琥珀酰胆碱和罗库溴铵在猪模型中对 RLN 进行 IONM 时对喉肌的恢复情况。9 只雄性杜洛克-兰德雷斯小猪用硫喷妥钠麻醉，并在不使用神经肌肉阻滞剂（NMBAs）的情况下进行气管插管。针电极通过环甲韧带插入杓状肌。暴露 RLN 并进行刺激。静脉注射 NMBA 前后获取肌电图（EMG）信号。在给予研究药物前后（每隔 1 分钟测量一次）测量 EMG 幅度，直到完全恢复。研究中的 NMBA 方案包括琥珀酰胆碱（1mg/kg）、低剂量罗库溴铵（0.3mg/kg）和标准剂量罗库溴铵（0.6mg/kg）。记录和分析最大神经肌肉阻滞和对照反应的 80%恢复（即持续时间）。对照反应的 80%恢复，琥珀酰胆碱（1mg/kg）为 19.7±1.5 分钟；低剂量罗库溴铵（0.3mg/kg）为 16.3±2.5 分钟；标准剂量罗库溴铵（0.6mg/kg）为 29.3±5.7 分钟。琥珀酰胆碱（1mg/kg）和低剂量罗库溴铵（0.3mg/kg）的持续时间明显短于标准剂量罗库溴铵（0.6mg/kg）。琥珀酰胆碱和低剂量罗库溴铵组的 EMG 信号恢复在 30 分钟内恢复到基线，但罗库溴铵（0.6mg/kg）组直到手术后 1 小时才恢复到基线。在这项研究中，琥珀酰胆碱（1mg/kg）和低剂量罗库溴铵（0.3mg/kg）对喉肌的恢复情况良好。建议在甲状腺手术中 RLN 的 IONM 中，低剂量罗库溴铵可能替代琥珀酰胆碱用于全身麻醉的诱导。
