Neuromuscular blockade in anaesthesia for maxillofacial cancer surgery: specifics, advantages, challenges and solutions (literary review)
https://doi.org/10.17650/2222-1468-2025-15-2-85-91
Abstract
This review discusses the problem of safe, controlled myoplegia during anesthesia in patients with tumors of the maxillofacial area. Anatomical features of this category of patients affecting the permeability of the upper respiratory tract during standard induction of anesthesia are considered. Modern drugs for myoplegia and neuromuscular block reversal are presented. As an illustration, 2 clinical cases of using sugammadex for fast cessation of myorelaxant action in an emergency situation are described. Modern guidelines on safe use of myorelaxants and their antagonists for anesthesia in planned surgeries in maxillofacial oncological surgery are presented.
About the Authors
T. E. Selina
Clinical Hospital “Lapino” of the “Mother and Child” Group of companies
Russian Federation
Russian Federation
Tatiana Evgenievna Selina
111 1st Uspenskoe Shosse, Lapino, Moscow Region 143081
A. A. Afanasenkov
Clinical Hospital “Lapino” of the “Mother and Child” Group of companies
Russian Federation
Russian Federation
111 1st Uspenskoe Shosse, Lapino, Moscow Region 143081
V. E. Gruzdev
Clinical Hospital “Lapino” of the “Mother and Child” Group of companies
Russian Federation
Russian Federation
111 1st Uspenskoe Shosse, Lapino, Moscow Region 143081
References
1. Beecher H.K., Todd D.P. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948–1952, inclusive. Ann Surg 1954;140(1):2–35. DOI: 10.1097/00000658-195407000-00001
2. Petrikov S.S., Solodov A.A., Timerbaev V.Kh. et al. Residual neuromuscular block after the use of muscle relaxants in neurosurgical patients. Frequency of development, diagnosis, and reversion. Anesteziologiya i reanimatologiya = Anesthesiology and Intensive Care Medicine 2012;4:73–6. (In Russ.).
3. Blum F.E., Locke A.R., Nathan N. et al. Residual neuromuscular block remains a safety concern for perioperative healthcare professionals: a comprehensive review. J Clin Med 2024;13(3):861. DOI: 10.3390/jcm13030861
4. Piersanti A., Garra R., Sbaraglia F. et al. Neuromuscular monitoring and incidence of postoperative residual neuromuscular blockade: a prospective observational study. J Anesth Analg Crit Care 2025;5(1):5. DOI: 10.1186/s44158-025-00226-1
5. Kirienko P.A., Babayants A.V., Shmakov I.A. et al. Evaluation of the efficacy and safety of sugammadex for the reversal of neuromuscular block. Anesteziologiya i reanimatologiya = Anesthesiology and Intensive Care 2013;6:46–51. (In Russ.).
6. Caldwell J.E. Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium. Anesth Analg 1995;80(6):1168–74. DOI: 10.1097/00000539-199506000-00018
7. Frenkel M., Lien C.A. Eliminating residual neuromuscular blockade: a literature review. Ann Transl Med 2024;12(4):65. DOI: 10.21037/atm-23-1743
8. Cleere E.F., Read C., Prunty S. et al. Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations. Head Neck 2024;46(9):2363–74. DOI: 10.1002/hed.27868
9. Magomedov M.A., Zabolotskikh I.B. Myoplegia. Moscow: Prakticheskaya meditsina, 2010. 224 p. (In Russ.).
10. Kheterpal S., Vaughn M.T., Dubovoy T.Z. et al. Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (STRONGER): a multicenter matched cohort analysis. Anesthesiology 2020;132(6):1371–81. DOI: 10.1097/ALN.0000000000003256
11. Ploeger B.A., Smeets J., Strougo A. et al. Pharmacokineticpharmacodynamic model for the reversal of neuromuscular blockade by sugammadex. Anesthesiology 2009;110(1):95–105. DOI: 10.1097/ALN.0b013e318190bc32
12. Krylov V.V., Kondrat`ev A.N., Lubnin A.Yu. et al. Recommendations for the diagnosis and reversal of residual neuromuscular block in neurosurgery. Vestnik intentsivnoy terapii = Bulletin of Intensive Care 2011;5:52–62. (In Russ.).
13. Adam J.M., Bennett D.J., Bom A. et al. Cyclodextrin-derived host molecules as reversal agents for the neuromuscular blocker rocuronium bromide: synthesis and structure-activity relationships. J Med Chem 2002;45(9):1806–16. DOI: 10.1021/jm011107f
14. Suy K., Morias K., Cammu G. et al. Effective reversal of moderate rocuronium- or vecuronium-induced neuromuscular block with sugammadex, a selective relaxant binding agent. Anesthesiology 2007;106(2):283–8. DOI: 10.1097/00000542-200702000-00016
15. Schaller S.J., Fink H., Ulm K. et al. Sugammadex and neostigmine dose-finding study for reversal of shallow residual neuromuscular block. Anesthesiology 2010;113(5):1054–60. DOI: 10.1097/ALN.0b013e3181f4182a
16. Duvaldestin P., Kuizenga K., Saldien V. et al. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg 2010;110(1):74–82. DOI: 10.1213/ANE.0b013e3181c3be3c
17. Donati F., Meistelman C., Plaud B. Vecuronium neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis. Anesthesiology 1991;74(5):833–7. DOI: 10.1097/00000542-199105000-00006
18. Hagberg C.A. Benumof and Hagberg’s airway management. 3rd edn. Philadelphia: Saunders, 2013. Pp. 794–802.
19. Kim H.J., Lee K., Park W.K. et al. Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery. Br J Anaesth 2015;115(6):867–72. DOI: 10.1093/bja/aev368
20. Choi E.S., Oh A.Y., Koo B.W. et al. Comparison of reversal with neostigmine of low-dose rocuronium vs. reversal with sugammadex of high-dose rocuronium for a short procedure. Anaesthesia 2017;72(10):1185–90. DOI: 10.1111/anae.13894
21. Thilen S.R., Weigel W.A., Todd M.M. et al. 2023 American Society of Anesthesiologists practice guidelines for monitoring and antagonism of neuromuscular blockade: a report by the american society of anesthesiologists task force on neuromuscular blockade. Anesthesiology 138(1):13–41. DOI: 10.1097/ALN.0000000000004379
22. Calixto L., Almeida A. “Can’t intubate, can’t ventilate”: the use of sugammadex as a rescue technique – a case report: 19AP3-8. Eur J Anaesthesiology 2012;29:234.
23. Gorobets E.S., Anisimov M.A. Emergency decurarization with sugammadex in case of failed ventilation (clinical observation and problem analysis). Vestnik intentsivnoy terapii = Bulletin of Intensive Care 2012;3:71–8. (In Russ.).
24. Abou Nafeh N.G., Aouad M.T., Khalili A.F. et al. Use of sugammadex in “cannot intubate, cannot ventilate” scenarios: a systematic review of case reports. Anesth Analg 2025;140(4):931–7. DOI: 10.1213/ANE.0000000000007199
Review
For citations:
Selina T.E., Afanasenkov A.A., Gruzdev V.E. Neuromuscular blockade in anaesthesia for maxillofacial cancer surgery: specifics, advantages, challenges and solutions (literary review). Head and Neck Tumors (HNT). 2025;15(2):85-91. (In Russ.) https://doi.org/10.17650/2222-1468-2025-15-2-85-91
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