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.

• 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