• Koung-Shing Chu, Cheng-Jing Tsai, I-Cheng Lu, Kuang-Yi Tseng, Siu-Wah Chau, Che-Wei Wu, Ka-Wo Lee, Wen-Rei Kuo, and Feng-Yu Chiang.
• Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
• J Otolaryngol Head N. 2010 Aug 1;39(4):397-402.

ObjectiveThe objective of this study was to find a nondepolarizing muscle relaxant to replace succinylcholine during thyroid surgery with intraoperative neuromonitoring (IONM) because succinylcholine can cause severe adverse effects.DesignProspective study of 232 patients undergoing thyroidectomies.SettingA tertiary medical centre.MethodsOne hundred thirty-one patients received 0.5 mg/kg rocuronium (group R) and 101 patients received 0.5 mg/kg atracurium (group A) to facilitate electromyographic (EMG) endotracheal tube insertion. EMG signals were obtained from the vagus nerve before and after dissection of the recurrent laryngeal nerve and were defined as the V1 and the V2 signal, respectively. Accelerometry (twitch [% TW]) was used to monitor the quantitative degree of neuromuscular transmission at the adductor pollicis muscle.Main Outcome MeasuresThe amplitude (muV) of the V1 and V2 signals and the correlated degree of neuromuscular transmission (% TW).ResultsV1 and V2 signals were obtained from all patients successfully. The % TW at the V1 signal was significantly lower than that at the V2 signal in group R and group A. The mean recovery time from complete neuromuscular blockade to the initial twitch was 43.9 +/- 11 minutes. Only in the subgroup in which the correlated TW was 0% while eliciting the V1 signal were the amplitudes of the V1 signals significantly lower than those of the V2 signal in both groups.ConclusionsA single dose (0.5 mg/kg) of rocuronium and atracurium was feasible for IONM during thyroid surgery. This study showed that 44 minutes after administration of these two muscle relaxants is adequate for eliciting an EMG signal from the vagus nerve.

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