caa a22 4500 445374152 CHVBK 20180317142957.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1007/s00540-011-1209-1 doi (NATIONALLICENCE)springer-10.1007/s00540-011-1209-1 Intraoperative reversal of neuromuscular block with sugammadex or neostigmine during extreme lateral interbody fusion, a novel technique for spine surgery [Elektronische Daten] [Milan Adamus, Lumir Hrabalek, Tomas Wanek, Tomas Gabrhelik, Jana Zapletalova] Purpose: Extreme lateral interbody fusion (XLIF) is a method for stabilization of the lumbar spine. Intraoperatively, the surgeon identifies the lumbar nerve roots with a stimulator to prevent their injury. The objective of this study was to determine the extent to which shallow rocuronium-induced neuromuscular block must be intraoperatively reversed for reliable identification of nerve roots. Methods: General anesthesia (midazolam-propofol-sufentanil-oxygen/air/sevoflurane-rocuronium) was administered to all patients. Train-of-four (TOF) stimulation of the ulnar nerve at 15-s intervals and electromyographic response of the adductor pollicis muscle were used. During operation, the surgeon stimulated the lumbar nerve roots (5-10mA) to identify their course. At the appearance of two twitches to the TOF stimuli, sugammadex (2mg/kg) or neostigmine (0.04mg/kg) was administered. When the response to nerve root stimulation appeared, the TOF ratio was recorded. Results: When the response to nerve root stimulation with 10mA became detectable, the median (range) TOF ratios were 0.67 (0.50-0.81) and 0.65 (0.42-0.71) after sugammadex and neostigmine, respectively. Similarly, TOF ratios at the first detectable response to stimulation with 5mA were 0.88 (0.67-0.93) and 0.83 (0.61-0.93). After sugammadex and neostigmine, the respective intervals until TOF ratio ≥0.90 were 2.0 (0.8-3.3) and 15.9 (7.3-28.8)min. Conclusion: Intraoperative reversal of shallow rocuronium-induced block with either sugammadex or neostigmine is an efficient method. For reliable detection of lumbar nerve roots with a stimulating current of 10mA, the block should be reversed to a TOF ratio of at least 0.70. For a current intensity of 5mA, the TOF ratio should reach 0.90. Japanese Society of Anesthesiologists, 2011 XLIF nationallicence Rocuronium nationallicence Sugammadex nationallicence Neostigmine nationallicence Reversal nationallicence Neuromuscular block nationallicence Adamus Milan Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic aut Hrabalek Lumir Department of Neurosurgery, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic aut Wanek Tomas Department of Neurosurgery, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic aut Gabrhelik Tomas Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic aut Zapletalova Jana Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic aut Journal of Anesthesia Springer Japan 25/5(2011-10-01), 716-720 0913-8668 25:5<716 2011 25 540 https://doi.org/10.1007/s00540-011-1209-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-011-1209-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Adamus Milan Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic aut NATIONALLICENCE 700 1- Hrabalek Lumir Department of Neurosurgery, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic aut NATIONALLICENCE 700 1- Wanek Tomas Department of Neurosurgery, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic aut NATIONALLICENCE 700 1- Gabrhelik Tomas Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic aut NATIONALLICENCE 700 1- Zapletalova Jana Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/5(2011-10-01), 716-720 0913-8668 25:5<716 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer