Effect of reversal of residual neuromuscular blockade on the amplitude of motor evoked potentials: a randomized controlled crossover study comparing sugammadex and placebo.

Abstract

PURPOSE:

To compare the amplitude changes in motor evoked potentials (MEP) with reversal of residual neuromuscular blockade using sugammadex or placebo in patients with cervical myelopathy.

METHODS:

In this prospective randomized double-blind, placebo-controlled crossover trial, 38 patients with cervical myelopathy undergoing posterior cervical decompression and fusion were randomized to either sugammadex (2mg/kg) or placebo. The primary outcome measure was the increase in amplitude of the MEP in the first dorsal interossei (FDI) muscle at 3 min. Mann-Whitney U test was used to analyze the primary outcome measure.

RESULTS:

There was a significant increase in the amplitude of MEP at 3 min with sugammadex when compared to placebo group. The median (IQR) increase in MEP amplitude (μV) at 3 min from the left FDI in sugammadex and placebo group was 652.9 (142:1650) and 20.6 (-183.5:297.5) (p <0.001), respectively. Corresponding values from right FDI were 2153.4 (1400:4536.8) and 55(-65.2:480.8) (p=<0.001).

CONCLUSION:

Our study showed that there was a 200% increase in the MEP amplitude in the first dorsal interosseous muscle at 3 min following reversal of residual neuromuscular blockade with sugammadex. By ensuring that maximal MEP amplitude is recorded at baseline, early commencement of neuromonitoring can be achieved.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION:

The study was registered at http://clinicaltrials.gov , ID NCT03087513, Feb 5th 2018.

• Authors: Lashmi Venkatraghavan, Nathan Royan, Sarah L Boyle, Michael Dinsmore, Nancy Lu, Kristina Cushman, Eric M Massicotte, Atul Prabhu
• Journal: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (Neurol Sci) Vol. 43 Issue 1 Pg. 615-623 (Jan 2022) ISSN: 1590-3478 [Electronic] Italy
• PMID: 34041634 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2021. Fondazione Società Italiana di Neurologia.

Chemical References

• Neuromuscular Nondepolarizing Agents
• Sugammadex
• Rocuronium

Topics

• Cross-Over Studies
• Delayed Emergence from Anesthesia
• Double-Blind Method
• Evoked Potentials, Motor
• Humans
• Neuromuscular Blockade
• Neuromuscular Nondepolarizing Agents
• Prospective Studies
• Rocuronium
• Sugammadex