Deep neuromuscular blockade for endolaryngeal procedures: A multicenter randomized study

Area of Science:

• Anesthesiology
• Surgical Innovation
• Pharmacology

Background:

• Optimizing surgical conditions is crucial for patient safety and outcomes.
• Neuromuscular blockade (NMB) depth influences surgical field quality and anesthetic management.
• Endolaryngeal surgery presents unique challenges requiring precise muscle relaxation.

Purpose of the Study:

• To compare surgical conditions between deep and moderate neuromuscular blockade (NMB) during microscopic endolaryngeal surgery.
• To evaluate the efficacy of different rocuronium and sugammadex regimens for achieving and reversing NMB.

Main Methods:

• A multicenter, randomized trial involving 102 patients undergoing endolaryngeal surgery.
• Patients were assigned to moderate NMB (train-of-four 1-2) or deep NMB (post-tetanic count 1-2) using varying rocuronium doses.
• Surgical rating conditions (SRCs) and perioperative events were assessed, with sugammadex used for reversal.

Main Results:

• Deep NMB achieved clinically acceptable SRC in 100% of patients versus 89.6% in the moderate NMB group (P = .027).
• Vocal fold movement was significantly less frequent in the deep NMB group (32.7% vs. 70.8%).
• The deep NMB group required fewer additional rocuronium doses (20.4% vs. 47.9%) and had faster sugammadex reversal times.

Conclusions:

• Deep neuromuscular blockade with high-dose rocuronium and 4 mg/kg sugammadex provides superior surgical and anesthetic conditions for endolaryngeal surgery.
• Moderate NMB with lower rocuronium and sugammadex doses resulted in more vocal fold movement and required additional muscle relaxants.