title: Recovery of laryngeal nerve function with sugammadex after rocuronium-induced profound neuromuscular block.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of sugammadex in reversing profound rocuronium-induced neuromuscular block at the laryngeal adductor muscles using motor-evoked potentials (mMEPs).
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  University surgical center.
  
  
  METHODS
  Twenty patients with American Society of Anesthesiologists physical class I-II status who underwent propofol-remifentanil anesthesia for the surgery of the thyroid gland.
  
  
  METHODS
  Patients were enrolled for reversal of profound neuromuscular block (sugammadex 16 mg/kg, 3 minutes after rocuronium 1.2 mg/kg). To prevent laryngeal nerve injury during the surgical procedures, all patients underwent neurophysiologic monitoring using mMEPs from vocal muscles. At the same time, the registration of TOF-Watch acceleromyograph at the adductor pollicis muscle response to ulnar nerve stimulation was performed; recovery was defined as a train-of-four (TOF) ratio ≥0.9.
  
  
  RESULTS
  After injection of 16 mg/kg of sugammadex, the mean time to recovery of the basal mMEPs response at the laryngeal adductor muscles was 70 ± 18.2 seconds. The mean time to recovery of the TOF ratio to 0.9 was 118 ± 80 seconds. In the postoperative period, 12 patients received follow-up evaluation of the vocal cords and no lesions caused by the surface laryngeal electrode during electrophysiological monitoring were noted.
  
  
  CONCLUSIONS
  Recovery from profound rocuronium-induced block on the larynx is fast and complete with sugammadex. In urgent scenarios, "early" extubation can be performed, even with a TOF ratio ≤0.9. However, all procedures to prevent postoperative residual curarization should still be immediately undertaken.
authors.affiliation: Department of Anesthesia, Santa Maria Nuova Hospital, Florence, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pavoni
authors.affiliation: Department of Anesthesia and Intensive Care, University-Hospital Careggi, Florence, Italy. Electronic address: gianesello.lara@libero.it.
authors.forename: Lara
authors.initials: L
authors.lastname: Gianesello
authors.affiliation: Department of Spinal Unit, Section of Neurophysiology, University-Hospital Careggi, Florence, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Martinelli
authors.affiliation: Department of Medical Staff Services, Primary Children's Hospital, Lake City, UT, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Horton
authors.affiliation: Department of Anesthesia, Santa Maria Nuova Hospital, Florence, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nella
authors.affiliation: Department of Anesthesia, Santa Maria Nuova Hospital, Florence, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gori
authors.affiliation: Department of Anesthesia and Intensive Care, University-Hospital Careggi, Florence, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Simonelli
authors.affiliation: Department of Spinal Unit, Section of Neurophysiology, University-Hospital Careggi, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Scisciolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D000762:Anesthesia Recovery Period; D019054:Evoked Potentials, Motor / Q000187:drug effects; D005260:Female; D006801:Humans; D007823:Laryngeal Nerves / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009213:Myography / Q000379:methods; D019148:Neuromuscular Blockade / Q000379:methods*; D061886:Neuromuscular Monitoring / Q000379:methods; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D000077123:Rocuronium; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: Laryngeal muscles; Neurophysiologic monitoring; Profound neuromuscular block; Sugammadex