title: Repeated sugammadex reversal of muscle relaxation during lumbar spine surgery with intraoperative neurophysiological multimodal monitoring.
abstract: Intraoperative neurophysiological monitoring during spine surgery is usually acomplished avoiding muscle relaxants. A case of intraoperative sugammadex partial reversal of the neuromuscular blockade allowing adequate monitoring during spine surgery is presented. A 38 year-old man was scheduled for discectomy and vertebral arthrodesis throughout anterior and posterior approaches. Anesthesia consisted of total intravenous anesthesia plus rocuronium. Intraoperatively monitoring was needed, and the muscle relaxant reverted twice with low dose sugammadex in order to obtain adequate responses. The doses of sugammadex used were conservatively selected (0.1mg/kg boluses increases, total dose needed 0.4mg/kg). Both motor evoqued potentials, and electromyographic responses were deemed adequate by the neurophysiologist. If muscle relaxation was needed in the context described, this approach could be useful to prevent neurological sequelae. This is the first study using very low dose sugammadex to reverse rocuronium intraoperatively and to re-establish the neuromuscular blockade.
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. Electronic address: errando013@gmail.com.
authors.forename: C L
authors.initials: CL
authors.lastname: Errando
authors.affiliation: Servicio de Neurofisiología Clínica, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Blanco
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Politécnico La Fe, Valencia, Spain.
authors.forename: Ó
authors.initials: Ó
authors.lastname: Díaz-Cambronero
mesh_terms: D000328:Adult; D000732:Androstanols; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D009126:Muscle Relaxation; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex
keywords: Anestesia; Anesthesia; Cirugía de raquis; Fármacos bloqueantes neuromusculares; Intraoperative neurophysiological monitoring; Monitorización neurofisiológica intraoperatoria; Neuromuscular blocking drugs; Rocuronio; Rocuronium; Spine surgery; Sugammadex