Neuromuscular Blockade Antagonism for Thyroid Surgery During Intraoperative Neural Monitoring-An Anesthesia...

Area of Science:

• Anesthesiology
• Surgical Oncology
• Neurophysiology

Background:

• Thyroid surgery necessitates precise anesthetic management, particularly when using intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN).
• Neuromuscular blockade (NMB) is often employed, requiring effective reversal agents to ensure patient safety and surgical success.
• Balancing NMB reversal with the demands of IONM presents unique anesthetic challenges.

Purpose of the Study:

• To compare non-selective (neostigmine) and selective (sugammadex) reversal agents for NMB in thyroid surgery.
• To discuss the mechanisms of action, efficacy, and challenges associated with each agent concerning IONM quality.
• To review current evidence on optimizing NMB reversal for thyroidectomy with IONM.

Main Methods:

• A narrative review of existing literature.
• Literature search conducted across PubMed, MEDLINE, and Google Scholar up to November 2023.
• Inclusion of case studies, clinical trials, systematic reviews, and guidelines focusing on NMB reversal agents (sugammadex and neostigmine) in thyroid surgery with IONM.

Main Results:

• Sugammadex (0.5-1 mg/kg) ensures rapid and reliable neuromuscular function return, enhancing electromyography (EMG) signal quality.
• Potential for patient movement with sugammadex over-reversal can compromise surgical precision.
• Neostigmine (0.03-0.04 mg/kg) is a cost-effective alternative, with careful dosing supporting IONM signal integrity.

Conclusions:

• Tailored NMB reversal strategies are crucial for thyroidectomy procedures utilizing IONM.
• Further large-scale randomized trials are needed to standardize NMB reversal protocols for thyroid surgery with IONM.
• Optimizing anesthetic management is vital for preserving both surgical conditions and IONM quality.