The use of sugammadex for the reversal of vecuronium-induced neuromuscular block following intracranial surgery.

BACKGROUND: Total intravenous anaesthesia with propofol and remifentanil is widely used in neuroanaesthesiology and enables the quick recovery and early neurological assessment of patients. The administration of muscle relaxants carries a risk of residual relaxation following surgery. The administration of a suitable dose of sugammadex reverses the neuromuscular block irrespective of its depth and has none of the side effects associated with acetylcholinesterase inhibitors. The aim of the present study was to evaluate the usefulness of sugammadex for the reversal of vecuronium-induced effects following intracranial surgery.

METHODS: The study involved 38 women who underwent supratentorial tumour removal. These women were randomly divided into two groups. Total intravenous anaesthesia with propofol and remifentanil using target-controlled infusion was administered according to the Schnider and Minto models, respectively. Endotracheal intubation was performed after the target concentrations of propofol and remifentanil reached 4 μg mL⁻¹ and 4 ng mL⁻¹, respectively. Vecuronium (100 μg kg⁻¹) was administered, and no response to TOF stimulation was observed. Relaxation was continued via the continuous infusion of vecuronium (0.8-1.2 μg kg⁻¹ min⁻¹) to provide a TOF of 2 throughout the surgery. In group I, neuromuscular conduction was restored with intravenous sugammadex (2 mg kg⁻¹), whereas in group II, no reversal agents were administered.

RESULTS: The times of the return of spontaneous breathing, extubation, eye opening (both spontaneous and in response to a verbal command) were found to be longer in group II than group I.

CONCLUSION: The use of sugammadex following craniotomy accelerates the achievement of optimal extubation conditions.