Department of Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Head Neck. 2024 Dec;46(12):2917-2925. doi: 10.1002/hed.27826. Epub 2024 Jun 15.
To investigate feasibility of utilizing enhanced neuromuscular blocking agents with selective recovery protocol during thyroid surgery with intraoperative neuromonitoring (IONM).
Two-hundred and ninety patients were randomized into two groups: group A 0.3 mg/kg rocuronium and group B 0.6 mg/kg. Sugammadex 2 mg/kg was injected if needed followed initial vagal stimulation (V0). Electromyography signals from vagus and recurrent laryngeal nerves before and after resection were recorded as V1, V2, R1, and R2.
In group B, 30 patients (20.7%) had V0 signals <100 μV, compared to 9 (6.2%) in group A. After sugammadex administration, 144 patients (99.3%) in both groups achieved positive V1 signals. Group B demonstrated a shorter surgical time from rocuronium injection to V2 stimulation compared to group A, accompanied by a significantly lower incidence of intraoperative body movement (0 vs. 16 patients).
0.6 mg/kg rocuronium with selective use 2 mg/kg sugammadex for IONM in thyroid surgery can meet both anesthesia and surgery demands.
研究在术中神经监测（IONM）下甲状腺手术中使用具有选择性恢复方案的增强型神经肌肉阻滞剂的可行性。
将 290 名患者随机分为两组：A 组 0.3mg/kg 罗库溴铵和 B 组 0.6mg/kg。如果需要，初始迷走神经刺激（V0）后注射 2mg/kg 琥珀酸舒更葡糖钠。在切除前后记录来自迷走神经和喉返神经的肌电图信号作为 V1、V2、R1 和 R2。
B 组 30 名患者（20.7%）的 V0 信号<100μV，A 组为 9 名患者（6.2%）。给予琥珀酸舒更葡糖钠后，两组均有 144 名患者（99.3%）出现阳性 V1 信号。与 A 组相比，B 组从罗库溴铵注射到 V2 刺激的手术时间更短，同时术中体动的发生率明显更低（0 例比 16 例）。
IONM 下甲状腺手术中使用 0.6mg/kg 罗库溴铵和选择性使用 2mg/kg 琥珀酸舒更葡糖钠可满足麻醉和手术需求。
