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Impact of rocuronium on intraoperative neuromonitoring vagal amplitudes during thyroidectomy

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Abstract

Purpose

Neuromuscular blocking agents (NMBA) facilitate endotracheal intubation and reduce related laryngeal morbidity. However, NMBA interfere with intraoperative neuromonitoring amplitudes during thyroidectomy. The goal of this study was to evaluate the impact of rocuronium used for tracheal intubation on early intraoperative neuromonitoring vagal amplitudes observed during first thyroid lobe dissection.

Methods

This is an observational pharmacoepidemiological study with prospective data collection and retrospective analysis. During the study period, all consecutive patients who underwent thyroid surgery with neuromonitoring were included. Patients underwent endotracheal intubation either using a single dose of rocuronium (NMBA group) or without NMBA (NMBA-free group) according to the anesthesiologist’s preference.

Results

Six hundred six patients were included (213 NMBA and 393 NMBA-free group patients). At V1, 39 patients (18%) in the NMBA group had an amplitude < 100 µV (need for curarization reversal in 30 patients) and 13 patients (3.3%) in the NMBA-free group (p < 0.001). In the remaining 554 patients, the mean V1 amplitude was significantly decreased in the NMBA group (544 versus 685 µV; p < 0.001). After exclusion of 25 patients with loss of signal types 1 and 2 during dissection, the difference between mean V1 and mean V2 was significantly lower in NMBA group patients (− 22 versus − 86 µV; p = 0.016).

Conclusion

This study provides new data showing how NMBA used for tracheal intubation significantly decrease V1 amplitude baseline and modify amplitude variations from V1 to V2 values during the first thyroid lobe dissection.

Level of evidence

Pharmacoepidemiological study

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Data availability

Data are available if needed.

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Author information

Authors and Affiliations

  1. Department, of Anesthesiology, Université de Lorraine, CHRU Nancy-Brabois, Vandœuvre-lès-Nancy, France

    Ombeline Empis de Vendin, Thomas Fuchs-Buder & Denis Schmartz

  2. Department of Anesthesiology, Université Libre de Bruxelles, Brussels, Belgium

    Denis Schmartz

  3. Department of Oto-Rhino-Laryngology, Université de Lorraine, CHRU Nancy-Brabois, Vandœuvre-lès-Nancy, France

    Duc-Trung Nguyen & Patrice Gallet

  4. Department of Surgery (CVMC), Unit of Metabolic, Endocrine, and Thyroid Surgery, Université de Lorraine, CHRU Nancy-Brabois (7Eme Étage), Vandœuvre-lès-Nancy, France

    Florence Bihain, Claire Nomine-Criqui & Laurent Brunaud

  5. INSERM U1256, Faculty of Medicine, Université de Lorraine, CHRU Nancy-Brabois, Vandœuvre-lès-Nancy, France

    Laurent Brunaud

Authors
  1. Ombeline Empis de Vendin
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  2. Thomas Fuchs-Buder
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  3. Denis Schmartz
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  4. Duc-Trung Nguyen
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  5. Patrice Gallet
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  6. Florence Bihain
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  7. Claire Nomine-Criqui
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  8. Laurent Brunaud
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Contributions

Empis de Vendin O, acquisition of data, analysis and interpretation of data, and drafting of the manuscript; Fuchs-Buder T, study conception and design and critical revision of the manuscript; Schmartz D, analysis and interpretation of data and drafting of the manuscript; Nguyen DT, analysis and interpretation of data; Gallet P, acquisition of data and critical revision of the manuscript; Bihain F, acquisition of data and drafting of the manuscript; Nomine-Criqui C, acquisition of data and critical revision of the manuscript; and Brunaud L, study conception and design, acquisition of data, analysis and interpretation of data, and critical revision of the manuscript.

Corresponding author

Correspondence to Laurent Brunaud.

Ethics declarations

Ethical approval

Nancy CHRU University Hospital ethics committee, CPP Saisine N° 277 by 2020 August 25th (please see corresponding letter).

Consent to participate

Informed consent was obtained for each patient using a declared form (CNIL N° DC2014-2114).

Consent for publication

Informed consent was obtained for each patient using a declared form (CNIL N° DC2014-2114). This observational data collection was declared (CNIL N° R2015-22) and registered at clinicaltrials.gov (NCT03309384).

Competing of interest

TFB received honoraria from Merck (for lectures). All other authors have nothing to disclose.

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This paper was presented at the ESES meeting (European Society of Endocrine Surgery) May 16–18 2019 Granada Spain (Best oral presentation).

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de Vendin, O.E., Fuchs-Buder, T., Schmartz, D. et al. Impact of rocuronium on intraoperative neuromonitoring vagal amplitudes during thyroidectomy. Langenbecks Arch Surg 406, 2019–2025 (2021). https://doi.org/10.1007/s00423-021-02234-5

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  • DOI: https://doi.org/10.1007/s00423-021-02234-5

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