• Koung-Shing Chu, Sheng-Hua Wu, I-Cheng Lu, Cheng-Jing Tsai, Che-Wei Wu, Wen-Rei Kuo, Ka-Wo Lee, and Feng-Yu Chiang.
• Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
• World J Surg. 2009 Jul 1;33(7):1408-13.

BackgroundA short-acting depolarizing neuromuscular blocking agent (NMBA), succinylcholine, has been utilized for thyroid operations with intraoperative neuromonitoring (IONM). Because of its potential to cause serious side effects, this prospective study tried to determine the feasibility of IONM after administration of a nondepolarizing NMBA during thyroid operations.MethodsComplete IONM data for 179 patients who had normal cord mobility were investigated: 90 patients received an induction dose of rocuronium (group R) and 89 received atracurium (group A). Electromyography signals were obtained from the vagus nerve before and after resection of the thyroid lobe and were defined as V(1) and V(2) signals, respectively. Accelerometry (percent twitch) was used to monitor the quantitative degree of neuromuscular blockade.ResultsV(1) and V(2) signals were obtained successfully in all patients. The percent twitch at the V(1) signal was significantly lower than that at the V(2) signal in both groups (39% +/- 20% vs. 69% +/- 26% in group R; 35% +/- 28% vs. 56% +/- 35 % in group A; both p < 0.01). However, the magnitude of the V(1) and V(2) signals did not differ significantly in either in group (473.8 +/- 290.8 microV vs. 528 +/- 316.2 microV in group R; 584.8 +/- 394.3 microV vs. 637.8 +/- 458.2 microV in group A; both p > 0.05).ConclusionsA single dose of either rocuronium or atracurium was feasible for IONM during thyroid surgery and provided adequate muscle relaxation for tracheal intubation.

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