Comparing the effect between continuous infusion and intermittent bolus of rocuronium for intraoperative neurophysiologic monitoring of neurointervention under general anesthesia

Medicine (Baltimore). 2018 Dec;97(51):e13816. doi: 10.1097/MD.0000000000013816.


Background: Medical researchers have been reluctant to use neuromuscular blocking drugs (NMBD) during the use of intraoperative motor evoked potential (MEP) monitoring despite the possibility of patient movement. In this study, we compared the effects of no NMBD and continuous rocuronium infusion on the incidence of patient involuntary movement and MEP monitoring.

Methods: In this study, 80 patients who underwent neuro intervention with MEP monitoring were randomly assigned into 2 groups. After an anesthetic induction, bolus of rocuronium 0.1 mg/kg was injected when it was needed (for patient involuntary movement or at the request of the surgeon) in group B, and 5 mcg/kg/min of rocuronium were infused in group I study participants. The incidence of patient involuntary movement and spontaneous respiration, the mean MEP amplitude, coefficient of variation (CV), the incidence of MEP stimulus change and train-of-four (TOF) count were compared.

Results: The incidence of involuntary movement and spontaneous movement were measured as significantly lower in group I (P < .05). The incidence of undetectable MEP did not differ as measured in both groups. The means and CVs of MEP amplitude in all limbs were significantly lower in group I. The mean TOF counts from 30 to 80 min of operation were significantly higher in group B.

Conclusion: We conclude that the continuous infusion of rocuronium effectively inhibited the involuntary movement and spontaneous respiration of the patient while enabling MEP monitoring.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Evoked Potentials, Motor / drug effects*
  • Female
  • Humans
  • Infusions, Intravenous
  • Intraoperative Neurophysiological Monitoring / methods*
  • Male
  • Middle Aged
  • Neuromuscular Nondepolarizing Agents / administration & dosage*
  • Prospective Studies
  • Rocuronium / administration & dosage*


  • Neuromuscular Nondepolarizing Agents
  • Rocuronium