Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

Objectives/Hypothesis: Laser microlaryngeal surgery (LMS) is a short operation requiring brief and intense paralysis. Adequate muscle relaxation and rapid recovery of neuromuscular function are essential for improving surgical conditions and reducing the incidence of complications during LMS. However, the ideal muscle relaxant with a rapid onset and short duration of action is not yet available. Rocuronium has rapid onset at higher doses, but with a prolonged duration of action. Sugammadex is a selective relaxant-binding agent that allows for rapid reversal of rocuronium-induced neuromuscular blockade. This study aimed to compare the surgical conditions and anesthesia time between two combinations of neuromuscular blocker and reversal agent, rocuronium-sugammadex (R-S) and succinylcholine-cisatracurium-pyridostigmine (S-C-P), and propose an optimal anesthetic regimen for improving the surgical conditions in LMS patients. Study Design: Prospective, randomized, double-blinded clinical study. Methods: Patients in the R-S group received 1 mg/kg rocuronium bromide, whereas those in the S-C-P group received 1 mg/kg succinylcholine. After endotracheal intubation, 0.08 mg/kg cisatracurium was injected in S-C-P patients. After the procedure, R-S patients received 2 mg/kg sugammedex, whereas S-C-P patients received 0.2 mg/kg pyridostigmine plus 10 μg/kg atropine. Results: In the R-S group, surgical condition scores were significantly higher and anesthesia time was significantly shorter. The use of additive neuromuscular blocking agents was significantly higher in the S-C-P group. Conclusions: Muscle relaxation with rocuronium and reversal with sugammadex resulted in better surgical conditions and a shorter anesthesia time in patients undergoing LMS when compared to the S-C-P regimen. Level of Evidence: 1b Laryngoscope, 127:1135–1139, 2017.