Highlights
- •Lingering rocuronium effects affect perceived patient neurologic status.
- •Rocuronium lingering effects can be prolonged in acute neurosurgical patients.
- •Rocuronium reversal can drastically impact neurosurgical decision making.
- •Sugammadex can serve as a useful tool in acute neurosurgical settings.
Abstract
Objective
Sugammadex reversal of neuromuscular blocking agents (NMBAs) is usually performed
postoperatively. A scarcity of literature exists exploring sugammadex use for timely
neurological examination of neurosurgical patients. NMBAs, like rocuronium, are used
in the Emergency Department during intubation and their unpredictable duration of
action often impedes timely and accurate assessment of patient neurological status.
We aim to explore the role of sugammadex in evaluating patients in need of acute neurosurgical
care.
Methods
Retrospective assessment of patients presenting with traumatic brain injury or intracranial
hemorrhage was conducted at our level 1 trauma center. Patients of interest were those
for whom sugammadex reversal of rocuronium neuromuscular blockade, from intubating
doses, was pursued to ensure timely neurologic assessment. Nine patients were identified
for whom GCS pre-/post-sugammadex, rocuronium dosing, elapsed time between rocuronium
administration and reversal, and clinical course data were retrieved.
Results
Arrival GCS was 5.2 ± 3.2, with intubation accomplished within 10 ± 2.5 min of presentation.
Rocuronium dosing was consistent between patients, average single dose of 1.2 ± 0.3 mg/kg.
Lingering neuromuscular blockade ranged from 28 to 132 min (87.3 ± 34.3 min). All
patients exhibited a GCS of 3 T upon initial neurosurgical evaluation, prior to reversal.
Post-reversal GCS rose to 6.0 T ± 2.2. Sugammadex facilitated more accurate clinical
decision making in 8 of 9 patients, including prevention of unnecessary invasive procedures.
Two of 9 patients were eventually discharged home or to a rehabilitation facility.
Conclusions
Rocuronium neuromuscular blockade can linger beyond pharmacokinetic predictions, thus
delaying timely and precise neurologic assessment. Our data suggests sugammadex may
be a useful addition to the clinician’s armamentarium for acute neurologic assessment
in the neurosurgical population. Sugammadex may impact clinical decision-making in
certain patients and allow for more informed decision-making by families and physicians
alike. Prospective studies are needed to definitively assess the impact of sugammadex
on outcomes in acute neurosurgical settings.
Keywords
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Article info
Publication history
Accepted:
August 10,
2022
Received:
April 4,
2022
Identification
Copyright
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