Neuromuscular blockade in neuroanesthesiology. Case report and literature review

Lubnin A.Yu.; Yusupov R.I.; Kulikov A.S.; Shevchenko K.V.

doi:https://doi.org/10.17116/anaesthesiology202205160

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Abstract:

The authors present such a serious and potentially life-threatening complication as unplanned intraoperative movement of patient that required changing surgical and anesthetic strategy. Literature review is devoted to management of neuromuscular blockade during different neurosurgical interventions, including surgery under intraoperative neurophysiological control, and also the problem of unplanned intraoperative mobility. Important role in prevention of these vents is assigned to rational use of muscle relaxants.

Keywords:

intraoperative movements

muscle relaxants

neuromuscular blockade

complications

hydrocephalus

endoscopic third ventriculostomy

Authors:

Lubnin A.Yu.

Burdenko Neurosurgical Center

RSCI AuthorID: 370609
Scopus AuthorID: 57192157123
ORCID: 0000-0003-2595-5877

Yusupov R.I.

City Clinical Hospital No. 7

ORCID: 0009-0007-0671-2833

Kulikov A.S.

Burdenko Neurosurgical Center

Shevchenko K.V.

Burdenko Neurosurgical Center

RSCI AuthorID: 479731
Scopus AuthorID: 57197676732
ORCID: 0000-0003-3732-6664

Received:

27.04.2022

Accepted:

02.06.2022

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References:

Plaud B, Baillard C, Bourgain JL, Bouroche G, Desplanque L, Devys JM, Fletcher D, Fuchs-Buder T, Lebuffe G, Meistelman C, Motamed C, Raft J, Servin F, Sirieix D, Slim K, Velly L, Verdonk F, Debaene B. Guidelines on muscle relaxants and reversal in anaesthesia. Anaesthesia, Critical Care and Pain Medicine. 2020;39(1):125-142. https://doi.org/10.1016/j.accpm.2020.01.005
Kim WH, Lee JJ, Lee SM, Park MN, Park SK, Seo DW, Chung IS. Comparison of motor-evoked potentials monitoring in response to transcranial electrical stimulation in subjects undergoing neurosurgery with partial vs no neuromuscular block. British Journal of Anaesthesia. 2013;110(4):567-576. https://doi.org/10.1093/bja/aes395
Kirmeier E, Eriksson LI, Lewald H, Jonsson Fagerlund M, Hoeft A, Hollmann M, Meistelman C, Hunter JM, Ulm K, Blobner M; POPULAR Contributors. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study. The Lancet. Respiratory Medicine. 2019;7(2):129-140. https://doi.org/10.1016/S2213-2600(18)30294-7
Singh GP, Prabhakar H, Bithal PK, Dash HH. A retrospective analysis of perioperative complications during intracranial neuroendoscopic procedures: our institutional experience. Neurology India. 2011;59(6):874-878. https://doi.org/10.4103/0028-3886.91368
Matta BF, Menon DK, Turner JM, eds. Textbook of Neuroanaesthesia and Critical Care. London: GMM; 2000.
Mongan PD, Soriano SGIII, Sloan TB, eds. A Practical Approach to Neuroanesthesia. Wolter Kluwer/Lippincot Williams & Wilkins; 2013.
Manevich AZ, Salalykin VI. Nejroanesteziologiya. M.: Medicina; 1978. (In Russ.).
Mizikov VM. Teorii i mekhanizmy obshchej anestezii. Sovremennaya koncepciya mnogokomponentnosti. V kn.: Anesteziologiya. Nacional’noe rukovodstvo. Pod red. Bunyatyana A.A., Mizikova V.M. M.: GEOTAR; 2017. (In Russ.).
Fink H, Blobner M, Martyn JAJ. Neuromuscular blocking drugs. In: Anesthetic Pharmacology. Cambridge. Medicine. Eds. Evers AS. 2nd ed.; 2011.
Kopman AF. Perioperative monitoring of neuromuscular function. In: Monitoring in Anesthesia and Perioperative Care. Eds. Reich DL. Cambridge University Press; 2011.
Naguib M. Drug for reversal of neuromuscular blockade. In: Anesthetic Pharmacology. Cambridge. Medicine. 2nd ed.; 2011.
Sloan T, Koht A. General anesthetic considerations in intraoperative monitoring. In: Intraoperative Neuromonitoring. Loftus C.M., Biller J., Baron E.M., eds. McGraw Hill; 2014.
Gorobec ES, Balandin VV, Anisimov MA, Gruzdev VE, Bekyashev AKh. Tactics of muscle relaxation with the use of sugammadex during surgery that required neurophysiological monitoring. Anesteziologiya i reanimatologiya. 2012;4:80-82. (In Russ.).
Ezhevskaya AA, Prusakova ZhB, Zagrekov VI. Tactics of sugammadex decurarization for intra- and postoperative awakening of patients with repeated administration of rocuronium in spinal surgery. Anesteziologiya i reanimatologiya. 2017;3:194-198. (In Russ.).
Hans P, Bonhomme V. Muscle relaxants in neurosurgical anesthesia: a critical appraisail. European Journal of Anaesthesiology. 2003;20(8):600-605. https://doi.org/10.1017/s0265021503000966
Guo L, Gelb AW. The use of motor evoked potential monitoring during cerebral aneurysm surgery to predict pure motor deficits due to subcortical ischemia. Clinical Neurophysiology. 2011;122(4):648-655. https://doi.org/10.1016/j.clinph.2010.09.001
Guo L, Gelb AW. False negatives, muscle relaxants, and motor evoked potentials. Journal of Neurosurgical Anesthesiology. 2011;23(1):64. https://doi.org/10.1097/ANA.0b013e3181f57313
Irie Y, Yoshitami K, Sasaki Y, Shinzawa M, Miura N, Kusaka Y, Miyazaki S. The efficacy of motor evoked potentials on cerebral aneurysm surgery and new onset postoperative motor deficits. Journal of Neurosurgical Anesthesiology. 2010;22(3):247-251. https://doi.org/10.1097/ANA.0b013e3181de4eae
Motoyama Y, Kawaguchi M, Yamada S, Nakagawa I, Nishimura F, Hironaka Y, Park YS, Hayashi H, Abe R, Nakase H. Evaluation of combined use of transcranial and direct cortical motor evoked potentials monitoring during unruptured aneurysms surgery. Neurologia Medico-Chirurgica. 2011;51(1):15-22. https://doi.org/10.2176/nmc.51.15
Sloan TB, Janik D, Jameson L. Multimodal monitoring of the central nervous system using motor evoked potentials. Current Opinion in Anaesthesiology. 2008;21(5):560-564. https://doi.org/10.1097/ACO.0b013e32830f1fbd
Yeon JJ, Seo DW, Hong SC, Kim JS. Transcranial motor evoked potential monitoring during the surgical clipping of unruptured intracranial aneurysms. Journal of the Neurological Sciences. 2010;293(1-2):29-34. https://doi.org/10.1016/j.jns.2010.03.013
Hemmer LB, Zeeni C, Bebawy JF, Bendok BR, Cotton MA, Shah NB, Gupta DK, Koht A. The Incidence of Unacceptable Movement with Motor Evoked Potentials during Craniotomy for Aneurysm Clipping. World Neurosurgery. 2014;81(1):99-104. https://doi.org/10.1016/j.wneu.2012.05.034
Quinoses-Hinojosa A, Alan M, Lion R, Yingling CD, Lawton MT. Transcranial motor evoked potentials during basilar artery aneurysm surgery: Technical applicacation for 30 consecutive patients. Neurosurgery. 2004;54(4):916-924. https://doi.org/10.1227/01.neu.0000114511.33035.af
Suzuki K, Mikami T, Sugino N, Wanibuchi M, Miyamoto S, Hasimoto N, Mikuni N. Discrepancy between voluntary movement and motor-evoked potentials in evaluation of motor function during clipping of anterior circulation aneurysms. World Neurosurgery. 2014;82(6):739-745. https://doi.org/10.1016/j.wneu.2013.08.034
Abdulrauf SI, Vuong P, Patel R, Sampath R, Ashour AM, Germany LM, Lebovitz J, Brunson C, Nijjar Y, Dryden JK, Khan MQ, Stefan MG, Wiley E, Cleary RT, Reis C, Walsh J, Buchanan P. «Awake» clipping of cerebral aneurysms: report of initial series. Journal of Neurosurgery. 2017;127(2):311-318. https://doi.org/10.3171/2015.12.JNS152140
Kulikov AS, Shekhtman OD, Gorozhanin VA, Lubnin AYu. Craniotomy in consciousness during clipping of an arterial aneurysm of the brain. Clinical observation. Vestnik intensivnoj terapii im. A.I. Saltanova. 2018;3:97-100. (In Russ.). https://doi.org/10.21320/1818-474X-2018-3-97-100
Abla AA, Lawton MT. Awake motor examination during intracranial aneurysm surgery. World Neurosurgery. 2014;82(6):683-684. https://doi.org/10.1016/j.wneu.2013.09.032
Cannizzaro D, Peshillo S, Mancarella C, La Pira B, Pastelli E, Passacantilli E, Santoro A. Cliping in awake surgery as end-stage in a complex internal carotid artery aneurysm after failure of multimodal endovascular and extracranial-intracranial bypass treatment. Journal of Stroke and Cerebrovascular Diseases. 2017;26(6):114-118. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.03.028
Luders JC, Steinmetz MP, Mayberg MR. Awake craniotomy for microsurgical obliteration of mycotic aneurysms: technical report of three cases. Neurosurgery. 2005;56(1 suppl):E201. https://doi.org/10.1227/01.neu.0000144491.14623.92
Maurtua MA, Deogaonkar A, Bakri MH, Masha E, Na J, Foss J, Sessler DI, Lotto M, Ebrahim Z, Schubert A. Dosing of remifentanil to prevent movement during craniotomy in the absence of neuromuscular blockade. Journal of Neurosurgical Anesthesiology. 2008;20(4):221-225. https://doi.org/10.1097/ANA.0b013e3181806c4a
Debaene B, Pland B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dosage of nondepolarizing muscle relaxant with intermidiate duration of action. Anesthesiology. 2003;98(5):1042-1048. https://doi.org/10.1097/00000542-200305000-00004
Cavallone LF, Vanucci A. Extubation of the difficult airway and extubation failure. Anesthesia and Analgesia. 2013;116(2):368-383. https://doi.org/10.1213/ANE.0b013e31827ab572
Murphy GS, Brull SJ. Residual neuromuscular block: Lesson unlearned. Part I. Definitions? Incidence and adverse physiologic effect of residual neuromuscular block. Anesthesia and Analgesia. 2010;111(1):120-128. https://doi.org/10.1213/ANE.0b013e3181da832d
Nitby HR, Maltese A, Stahl N. Early postoperative hematomas in neurosurgery. Acta Neurochirurgica. 2016;158(5):837-846. https://doi.org/10.1007/s00701-016-2778-4
Yamada K, Abe Y, Satoh S, Yanagibashi Y, Hyakumachi T, Masuda T. Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine. 2015;40(13):1046-1052. https://doi.org/10.1097/BRS.0000000000000876
Lillemae K, Jarvio JA, Silvasti-Lundell MK, Antinheimo JJ-P, Hernisniemi JA, Niemi TT. Incidence of postoperative hematomas requiring surgical treatment in neurosurgery: A retrospective observational study. World Neurosurgery. 2017;108:491-497. https://doi.org/10.1016/j.wneu.2017.09.007
Kageji T, Nagahiro S, Mizobuchi Y, Nakaima K. Postoperative hematoma requiring recraniotomy in 1149 patients with intracranial tumors. Operative Neurosurgery. 2017;13(3):392-397. https://doi.org/10.1093/ons/opw045
Petrikov SS, Solodov AA, Timerbaev VKh, Efremenko SV, Golubev VA, Komardina EV, Krylov VV. Residual neuromuscular block after the use of muscle relaxants in neurosurgical patients. Frequency of development, diagnosis and reversion. Anesteziologiya i reanimatologiya. 2012;4:73-76. (In Russ.).
Cammu G. Residual neuromuscular blockade and postoperative pulmonary complications: Wyan does the recent evidence demonstrate? Current Anesthesiology Reports. 2020;10(2):131-136. https://doi.org/10.1007/s40140-020-00388-4
Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults (Review). Cochrane Database of Systematic Reviews. 2017;8(8):CD012763. https://doi.org/10.1002/14651858.CD012763
Kulikov A, Lubnin A. Anesthesia for awake craniotomy. Current Opinion in Anaesthesiology. 2018;31(5):506-510. https://doi.org/10.1097/ACO.0000000000000625
Meng L, Berger M, Gelb AW. The potential benefits of awake craniotomy for brain resection: An anesthesiologist’s perspective. Journal of Neurosurgical Anesthesiology. 2015;27(4):310-317. https://doi.org/10.1097/ANA.0000000000000179
Sewell D, Smith M. Awake craniotomy: anesthetic considerations based on outcome evidence. Current Opinion in Anaesthesiology. 2019;32(5):546-552. https://doi.org/10.1097/ACO.0000000000000750
Sheshadri V, Venkatraghavan L, Manninen P, Bernstein M. Anesthesia for same day discharge after craniotomy: Review of a single center experience. Journal of Neurosurgical Anesthesiology. 2018;30(4):299-304. https://doi.org/10.1097/ANA.0000000000000483