Intraoperative neuromonitoring (IONM) is frequently used during spinal surgeries that carry the risk of neurological damage. Real-time detection of compromised nerve function by IONM allows the surgeon to address possible causes and avoid permanent injury. Transcranial motor evoked potentials (TceMEPs) are muscle action potentials elicited by transcranial brain stimulation and have been the most widely used method of IONM because of their high sensitivity for detecting neurologic injury. Electrical stimulation applied over the motor cortex allows compound motor action potentials to be recorded peripherally. TceMEP monitoring plays an important role in preventing motor dysfunction during spinal surgery. Neuromuscular blockade (NMB) acts at the neuromuscular junction and leads to a dramatic loss of TceMEP signals. For most cases requiring TceMEPs, the use of NMB is omitted after intubation. However, evidence is still conflicting regarding the optimal level of NMB during such monitoring since appropriate muscle relaxation facilitates surgery, optimizes anaesthetic management, and prevents patient movement. Partial NMB (pNMB) induced by constant infusion of muscle relaxants according to the amplitude of muscle responses to “train of four†TOF has been applied in TceMEP monitoring. Notably, this approach increases technical and interpretive complexity and runs the risk of inadvertently disabling TceMEPs at a critical moment. The incidence of monitoring failure and false-positive results was increased under pNMB. Sugammadex is a novel reversal agent that selectively binds to vecuronium in the plasma and consequently lowers the vecuronium concentration at the neuromuscular junction. Multiple studies have confirmed the efficacy of reversing various levels of rocuronium block by Sugammadex. We hypothesized that the muscle relaxation reversal effect of sugammadex can increase the success rate of TceMEP recording in spinal surgery as compared to neostigmine. The study aimed to investigate the administration of Sugammadex versus Neostigmine after tracheal intubation shortens time to successful intraoperative neuromonitoring during spine surgery |