The effect of routine reversal of XXXX on adequacy of recurrent laryngeal nerve stimulation during thyroid surgery.

@entity1 @entity4094 @entity5159 @entity128 @entity10445 @entity1339
Testing of the integrity of the recurrent laryngeal nerve during thyroid surgery has become routine practice for many surgeons to aid dissection and minimise the chance of @entity128 . We hypothesised that routine reversal of an intermediate-acting, non-depolarising neuromuscular blocking agent would improve conditions for stimulation of the recurrent laryngeal nerve. We conducted a single-centre, randomised, double-blind placebo-controlled trial of @entity1 undergoing thyroid surgery by the same surgeon. After randomisation, the @entity1 received either @entity1339 2.5 mg with @entity10445 0.4 mg or placebo, at 30 minutes after induction of anaesthesia and administration of 0.4 mg/kg of @entity5159 . The primary outcome was the subjective assessment by the surgeon as to whether the neuromuscular function was adequate for stimulation of the recurrent laryngeal nerve using a neuromuscular integrity monitor (NIM). Time to NIM stimulation was 44.6 minutes in the placebo group and 41.4 minutes in the intervention group (P=0.268). Of the 21 @entity1 who received the @entity4094 reversal, 20 (95.2%) had adequate surgical conditions for NIM stimulation, compared to 9 out of 18 @entity1 (50%) in the placebo group (P=0.002). Three of the ten @entity1 (30%) with inadequate reversal showed no evidence of residual blockade assessed peripherally. The routine reversal of @entity4094 at 30 minutes post induction appears to result in adequate surgical conditions for safe stimulation of the recurrent laryngeal nerve. @entity4094 at a peripheral site does not guarantee adequate laryngeal muscle function for use of the NIM.
