title: Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery.
abstract: OBJECTIVE
  Laser microlaryngeal surgery (LMS) is a short operation requiring brief and intense paralysis. Adequate muscle relaxation and rapid recovery of neuromuscular function are essential for improving surgical conditions and reducing the incidence of complications during LMS. However, the ideal muscle relaxant with a rapid onset and short duration of action is not yet available. Rocuronium has rapid onset at higher doses, but with a prolonged duration of action. Sugammadex is a selective relaxant-binding agent that allows for rapid reversal of rocuronium-induced neuromuscular blockade. This study aimed to compare the surgical conditions and anesthesia time between two combinations of neuromuscular blocker and reversal agent, rocuronium-sugammadex (R-S) and succinylcholine-cisatracurium-pyridostigmine (S-C-P), and propose an optimal anesthetic regimen for improving the surgical conditions in LMS patients.
  
  
  METHODS
  Prospective, randomized, double-blinded clinical study.
  
  
  METHODS
  Patients in the R-S group received 1 mg/kg rocuronium bromide, whereas those in the S-C-P group received 1 mg/kg succinylcholine. After endotracheal intubation, 0.08 mg/kg cisatracurium was injected in S-C-P patients. After the procedure, R-S patients received 2 mg/kg sugammedex, whereas S-C-P patients received 0.2 mg/kg pyridostigmine plus 10 μg/kg atropine.
  
  
  RESULTS
  In the R-S group, surgical condition scores were significantly higher and anesthesia time was significantly shorter. The use of additive neuromuscular blocking agents was significantly higher in the S-C-P group.
  
  
  CONCLUSIONS
  Muscle relaxation with rocuronium and reversal with sugammadex resulted in better surgical conditions and a shorter anesthesia time in patients undergoing LMS when compared to the S-C-P regimen.
  
  
  METHODS
  1b Laryngoscope, 127:1135-1139, 2017.
authors: Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Hyub
authors: H
authors: Huh
authors: Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Seol Ju
authors: SJ
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Hyong Hwan
authors: HH
authors: Lim
authors: Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Kwang Yoon
authors: KY
authors: Jung
authors: Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Seung-Kuk
authors: SK
authors: Baek
authors: Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Seung Zhoo
authors: SZ
authors: Yoon
authors: Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Hye Won
authors: HW
authors: Lee
authors: Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Hye Ja
authors: HJ
authors: Lim
authors: Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Jang Eun
authors: JE
authors: Cho
mesh_terms: D000556:Ambulatory Surgical Procedures; D000732:Androstanols / Q000008:administration & dosage*; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007818:Laryngeal Diseases / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D011729:Pyridostigmine Bromide / Q000008:administration & dosage*; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage*; D000077122:Sugammadex; D013997:Time Factors; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D002800:Cholinesterase Inhibitors; D009466:Neuromuscular Blocking Agents; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D001279:Atracurium; D000077122:Sugammadex; D013390:Succinylcholine; D011729:Pyridostigmine Bromide; C101584:cisatracurium; D000077123:Rocuronium
keywords: Laser microlaryngeal surgery; rocuronium; succinylcholine; sugammadex; surgical condition