Recovery of laryngeal nerve function with sugammadex after rocuronium-induced profound neuromuscular block

Study 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). Design: A prospective observational study. Setting: University surgical center. Patients: Twenty patients with American Society of Anesthesiologists physical class I-II status who underwent propofol-remifentanil anesthesia for the surgery of the thyroid gland. Interventions: 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. Measurement and main 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. (C) 2016 Elsevier Inc. All rights reserved.