Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Front Endocrinol (Lausanne). 2022 Feb 10;13:817476. doi: 10.3389/fendo.2022.817476. eCollection 2022.
Neuromuscular blocking agents provide muscular relaxation for tracheal intubation and surgery. However, the degree of neuromuscular block may disturb neuromuscular transmission and lead to weak electromyography during intraoperative neuromonitoring. This study aimed to investigate a surgeon-friendly neuromuscular block degree titrated sugammadex protocol to maintain both intraoperative neuromonitoring quality and surgical relaxation during thyroid surgery.
A total of 116 patients were enrolled into two groups and underwent elective thyroid surgery with intraoperative neuromonitoring. All patients followed a standardized intraoperative neuromonitoring protocol with continuous neuromuscular transmission monitoring and received 0.6 mg/kg rocuronium for tracheal intubation. Patients were allocated into two groups according to the degree of neuromuscular block when the anterior surface of the thyroid gland was exposed. The neuromuscular block degree was assessed by the train-of-four (TOF) count and ratio. Patients in group I received sugammadex 0.25 mg/kg for non-deep neuromuscular block degree (TOF count = 1~4). Patients in group II were administered sugammadex 0.5 mg/kg for deep neuromuscular block degree (TOF count = 0). The quality of the intraoperative neuromonitoring was measured using the V electromyography (EMG) amplitude. An amplitude less than 500 μV and greater than 500 μV was defined as weak and satisfactory, respectively.
The quality of the intraoperative neuromonitoring was not different between groups I and II (satisfactory/weak: 75/1 vs. 38/2, = 0.14). The quality of surgical relaxation was acceptable after sugammadex injection and showed no difference between groups [55/76 (72.3%) in group I vs. 33/40 (82.5%) in group II, = 0.23].
This surgeon-centered sugammadex protocol guided by neuromuscular block degree (0.5 mg/kg for deep block and 0.25 mg/kg for others) showed comparably high intraoperative neuromonitoring quality and adequate surgical relaxation. The results expanded the practicality of sugammadex for precise neuromuscular block management during monitored thyroidectomy.
神经肌肉阻滞剂可提供气管插管和手术所需的肌肉松弛。然而，神经肌肉阻滞的程度可能会干扰神经肌肉传递，并导致术中神经监测期间肌电图减弱。本研究旨在探讨一种便于外科医生操作的神经肌肉阻滞程度滴定舒更葡糖钠方案，以维持甲状腺手术期间术中神经监测的质量和手术松弛。
将 116 例患者纳入两组，行择期甲状腺手术并进行术中神经监测。所有患者均遵循标准化的术中神经监测方案，连续进行神经肌肉传递监测，并在气管插管时给予 0.6mg/kg 罗库溴铵。根据甲状腺前表面暴露时的神经肌肉阻滞程度将患者分配至两组。神经肌肉阻滞程度通过四成串刺激（TOF）计数和比值评估。TOF 计数=1~4 时，组 I 患者给予舒更葡糖钠 0.25mg/kg；TOF 计数=0 时，组 II 患者给予舒更葡糖钠 0.5mg/kg。采用 V 肌电图（EMG）振幅测量术中神经监测质量。振幅小于 500μV 和大于 500μV 分别定义为弱和满意。
两组间术中神经监测质量无差异（满意/弱：75/1 例比 38/2 例，=0.14）。舒更葡糖钠注射后手术松弛质量可接受，两组间无差异[76 例中 55 例（72.3%）满意比 40 例中 33 例（82.5%）满意，=0.23]。
本研究以神经肌肉阻滞程度为指导的（深度阻滞时 0.5mg/kg，其他情况时 0.25mg/kg）舒更葡糖钠方案，术中神经监测质量高，手术松弛充分。该结果扩展了舒更葡糖钠在监测性甲状腺切除术中精确神经肌肉阻滞管理中的实用性。
