Investigation of potential neuropharmacological activity of neostigmine-glycopyrrolate for intraoperative neural monitoring in thyroid surgery.
Female
Glycopyrrolate
/ antagonists & inhibitors
Humans
Intubation, Intratracheal
Laryngeal Nerve Injuries
/ prevention & control
Male
Middle Aged
Monitoring, Intraoperative
Neostigmine
/ antagonists & inhibitors
Neuromuscular Blockade
/ adverse effects
Neuromuscular Nondepolarizing Agents
/ administration & dosage
Retrospective Studies
Rocuronium
/ administration & dosage
Thyroid Gland
/ surgery
glycopyrrolate
neostigmine
neuromuscular blockade
neuromuscular monitoring
thyroidectomy
Journal
The Kaohsiung journal of medical sciences
ISSN: 2410-8650
Titre abrégé: Kaohsiung J Med Sci
Pays: China (Republic : 1949- )
ID NLM: 100960562
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
08
08
2021
received:
14
06
2021
accepted:
18
08
2021
pubmed:
26
9
2021
medline:
26
3
2022
entrez:
25
9
2021
Statut:
ppublish
Résumé
Intraoperative neuromonitoring (IONM) is frequently used in thyroid surgery to reduce recurrent laryngeal nerve injury. The use of neuromuscular blockade agent to facilitate tracheal intubation, is a common cause of IONM failure. We performed a retrospective analysis to assess the efficacy of neostigmine-glycopyrrolate as a neuromuscular blockade reversal agent for IONM during thyroid surgery. Rocuronium (0.6 mg/kg) was administered for muscle relaxation. Neostigmine (2 mg) and glycopyrrolate (0.4 mg) were administered immediately after intubation. Cricothyroid muscle-twitch response upon external branch of superior laryngeal nerve stimulation and electromyography amplitudes of vagal and recurrent laryngeal nerves before (V1, R1) and after thyroid resection (V2, R2) were recorded. Fifty patients (23 males, 27 females) were included in the analysis. The diagnoses comprised 43 papillary thyroid carcinomas and seven benign diseases. The mean time between rocuronium injection and neostigmine-glycopyrrolate injection was 5.1 ± 1.2 min, and the mean time from neostigmine-glycopyrrolate injection to successful cricothyroid muscle twitching upon external branch of superior laryngeal nerve stimulation was 21.0 ± 4.5 min. All patients had V1 and R1 amplitudes of more than 500 μV each, with mean V1 and R1 amplitudes of 985.3 ± 471.6 μV and 1177.2 ± 572.7 μV, respectively. Neostigmine-glycopyrrolate was effectively used as a neuromuscular blockade reversal agent for IONM in thyroid surgeries without a significant increase in bucking events. Administration of neostigmine-glycopyrrolate immediately after intubation can be recommended for successful NMB reversal to facilitate IONM during thyroid surgery.
Substances chimiques
Neuromuscular Nondepolarizing Agents
0
Neostigmine
3982TWQ96G
Glycopyrrolate
V92SO9WP2I
Rocuronium
WRE554RFEZ
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
59-64Subventions
Organisme : This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea
ID : HC19C0103HI19C0481
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University.
Références
Wu CW, Dionigi G, Barczynski M, Chiang FY, Dralle H, Schneider R, et al. International neuromonitoring study group guidelines 2018: part II: optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope. 2018;128:S18-27.
Randolph GW, Kamani D. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve during thyroid and parathyroid surgery: experience with 1,381 nerves at risk. Laryngoscope. 2017;127:280-6.
Kim HY, Liu X, Wu CW, Chai YJ, Dionigi G. Future directions of neural monitoring in thyroid surgery. J Endocr Surg. 2017;17:96-103.
Dionigi G, Bartolo V, Rizzo AG, Marullo M, Fabiano V, Catalfamo A, et al. Improving safety of neural monitoring in thyroid surgery: educational considerations in learning new procedure. J Endocr Surg. 2018;18:21-36.
Lu IC, Wu SH, Wu CW. Neuromuscular blockade management for intraoperative neural monitoring. Kaohsiung J Med Sci. 2020;36:230-5.
Han YD, Liang F, Chen P. Dosage effect of rocuronium on intraoperative neuromonitoring in patients undergoing thyroid surgery. Cell Biochem Biophys. 2015;71:143-6.
Lu IC, Wu CW, Chang PY, Chen HY, Tseng KY, Randolph GW, et al. Reversal of rocuronium-induced neuromuscular blockade by sugammadex allows for optimization of neural monitoring of the recurrent laryngeal nerve. Laryngoscope. 2016;126:1014-9.
Sneyd JR, O'Sullivan E. Tracheal intubation without neuromuscular blocking agents: is there any point? Br J Anaesth. 2010;104:535-7.
Empis de Vendin O, Schmatz D, Brunaud L, Fuchs-Buder T. Recurrent laryngeal nerve monitoring and rocuronium: a selective sugammadex reversal protocol. World J Surg. 2017;41:2298-303.
Ledowski T, Hillyard S, Kozman A, Johnston F, Gillies E, Greenaway M, et al. Unrestricted access to sugammadex: impact on neuromuscular blocking agent choice, reversal practice and associated healthcare costs. Anaesth Intensive Care. 2012;40:340-3.
Lu IC, Wu SH, Chang PY, Ho PY, Huang TY, Lin YC, et al. Precision neuromuscular block management for neural monitoring during thyroid surgery. J Invest Surg. 2020;14:1-8.
Paech MJ, Kaye R, Baber C, Nathan EA. Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial. Anaesthesia. 2018;73:340-7.
Neely GA, Sabir S, Kohli A. Neostigmine. StatPearls. Treasure Island, FL: StatPearls Publishing; 2021.
Hunter JM. Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation. Br J Anaesth. 2017;119:i53-62.
Kim J, Moon HJ, Chai YJ, Lee JM, Hwang KT, Wu CW, et al. Feasibility of attachable ring stimulator for intraoperative Neuromonitoring during thyroid surgery. Int J Endocrinol. 2020;2020:5280939.
Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011;121:S1-16.
Ortega R, Brull SJ, Prielipp R, Gutierrez A, De La Cruz R, Conley CM. Monitoring neuromuscular function. N Engl J Med. 2018;378:e6.
Naguib M, Brull SJ, Johnson KB. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia. 2017;72:16-37.
Marshall SD, Boden E, Serpell J. The effect of routine reversal of neuromuscular blockade on adequacy of recurrent laryngeal nerve stimulation during thyroid surgery. Anaesth Intensive Care. 2015;43:485-9.
Gunes ME, Durai AC, Akarsu C, Guzey D, Sahbaz NA, Tulubas EK, et al. Effect of intraoperative neuromonitoring on efficacy and safety using sugammadex in thyroid surgery: randomized clinical trial. Ann Surg Treat Res. 2019;97:282-90.
Chai YJ, Lee JM, Won D, Lee J, Hwang JY, Kim YK, et al. Comparison of sugammadex dose for intraoperative neuromonitoring in thyroid surgery: a randomized controlled trial. Laryngoscope. 2021;29515. 131(9):2154-9.
Dogan E, Akdemir MS, Guzel A, Yildirim MB, Yildirim ZB, Kyuymcu M, et al. A miracle that accelerates operating room functionality: sugammadex. Biomed Res Int. 2014;2014:2014945310.
Ezri T, Boaz M, Sherman A, Armaly M, Berlovitz Y. Sugammadex: an update. J Crit Care Med (Targu Mures). 2016;2:16-21.
Flockton EA, Mastronardi P, Hunter JM, Gomar C, Mirakhur RK, Aguilera L, et al. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. Br J Anaesth. 2008;100:622-30.
Abad-Gurumeta A, Ripolles-Melchor J, Casans-Frances R, Espinosa A, Martinez-Hurtado F-PC, Ramirez JM, et al. A systematic review of sugammadex vs neostigmine for reversal of neuromuscular blockade. Anaesthesia. 2015;70:1441-52.
Lu IC, Wang HM, Shieh CF, Chiang FY, Wu CW, Tsai CJ. Electromyographic study of differential sensitivity to succinylcholine of the diaphragm, laryngeal and somatic muscles: a swine model. Kaohsiung J Med Sci. 2010;26:640-6.
Hemmerling TM, Schmidt J, Hanusa C, Wolf T, Schmitt H. Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles. Br J Anaesth. 2000;85:856-60.
Sung ES, Shin SC, Kwon HK, Lee YW, Lee JW, Jang HB, et al. Simple technique to preserve the external branch of the superior laryngeal nerve during thyroidectomy: clinical practicability of an attachable nerve stimulator. Asian J Surg. 2020;44:153-7.
Barczynski M, Konturek A, Stopa M, Honowska A, Nowak W. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg. 2012;36:1340-7.
Barczynski M, Randolph GW, Cernea C, International Neural Monitoring Study Group in Thyroid and Parathyroid Surgery. International survey on the identification and neural monitoring of the EBSLN during thyroidectomy. Laryngoscope. 2016;126:285-91.
Uludag M, Aygun N, Kartal K, Citgez B, Besler E, Yetkin G, et al. Contribution of intraoperative neural monitoring to preservation of the external branch of the superior laryngeal nerve: a randomized prospective clinical trial. Langenbecks Arch Surg. 2017;402:965-76.
Gurleyik E, Dogan S, Cetin F, Gurleyik G. Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery. Ann Surg Treat Res. 2019;96:269-74.