Intraoperative reversal of neuromuscular block with sugammadex or neostigmine during extreme lateral interbody fusion, a novel technique for spine surgery
Jazyk angličtina Země Japonsko Médium print-electronic
Typ dokumentu časopisecké články, randomizované kontrolované studie, práce podpořená grantem
- MeSH
- androstanoly farmakologie MeSH
- celková anestezie metody MeSH
- cholinesterasové inhibitory aplikace a dávkování MeSH
- fúze páteře metody MeSH
- gama-cyklodextriny aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbosakrální krajina chirurgie MeSH
- míšní kořeny účinky léků MeSH
- neostigmin aplikace a dávkování MeSH
- nervosvalová blokáda metody MeSH
- nervosvalové látky nedepolarizující aplikace a dávkování MeSH
- páteř chirurgie MeSH
- peroperační doba MeSH
- probouzení z anestezie MeSH
- rokuronium MeSH
- sugammadex MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- androstanoly MeSH
- cholinesterasové inhibitory MeSH
- gama-cyklodextriny MeSH
- neostigmin MeSH
- nervosvalové látky nedepolarizující MeSH
- rokuronium MeSH
- sugammadex MeSH
PURPOSE: Extreme lateral interbody fusion (XLIF) is a method for stabilization of the lumbar spine. Intraoperatively, the surgeon identifies the lumbar nerve roots with a stimulator to prevent their injury. The objective of this study was to determine the extent to which shallow rocuronium-induced neuromuscular block must be intraoperatively reversed for reliable identification of nerve roots. METHODS: General anesthesia (midazolam-propofol-sufentanil-oxygen/air/sevoflurane-rocuronium) was administered to all patients. Train-of-four (TOF) stimulation of the ulnar nerve at 15-s intervals and electromyographic response of the adductor pollicis muscle were used. During operation, the surgeon stimulated the lumbar nerve roots (5-10 mA) to identify their course. At the appearance of two twitches to the TOF stimuli, sugammadex (2 mg/kg) or neostigmine (0.04 mg/kg) was administered. When the response to nerve root stimulation appeared, the TOF ratio was recorded. RESULTS: When the response to nerve root stimulation with 10 mA became detectable, the median (range) TOF ratios were 0.67 (0.50-0.81) and 0.65 (0.42-0.71) after sugammadex and neostigmine, respectively. Similarly, TOF ratios at the first detectable response to stimulation with 5 mA were 0.88 (0.67-0.93) and 0.83 (0.61-0.93). After sugammadex and neostigmine, the respective intervals until TOF ratio ≥0.90 were 2.0 (0.8-3.3) and 15.9 (7.3-28.8) min. CONCLUSION: Intraoperative reversal of shallow rocuronium-induced block with either sugammadex or neostigmine is an efficient method. For reliable detection of lumbar nerve roots with a stimulating current of 10 mA, the block should be reversed to a TOF ratio of at least 0.70. For a current intensity of 5 mA, the TOF ratio should reach 0.90.
Zobrazit více v PubMed
Anesthesiology. 2003 May;98(5):1042-8 PubMed
Br J Anaesth. 2010 Nov;105(5):558-67 PubMed
Acta Anaesthesiol Scand. 2007 Aug;51(7):789-808 PubMed
J Crit Care. 2009 Mar;24(1):21-8 PubMed
Anaesthesia. 2011 Mar;66(3):217-9 PubMed
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011 Jun;155(2):165-71 PubMed
Anesth Analg. 2011 Jan;112(1):63-8 PubMed
Rozhl Chir. 2010 Dec;89(12):784-8 PubMed
Eur J Anaesthesiol. 2010 Oct;27(10):874-81 PubMed
Spine J. 2006 Jul-Aug;6(4):435-43 PubMed
Cas Lek Cesk. 2008;147(2):96-101 PubMed
Eur J Anaesthesiol. 2005 Sep;22(9):672-7 PubMed
Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S368-74 PubMed
