Comparisons of surgical conditions of deep and moderate neuromuscular blockade through multiple assessments and the quality of postoperative recovery in upper abdominal laparoscopic surgery - 14/06/21
Abstract |
Study objective |
To determine the effect of deep neuromuscular blockade (NMB) on surgical field conditions through multiple assessments during pneumoperitoneum and evaluate the effect of the depth of intraoperative NMB on the quality of postoperative recovery over multiple time periods.
Design |
Prospective randomized study.
Setting |
Operating room of a university hospital.
Patients |
Eighty non-morbidly obese patients (ASA physical status 1–2) who were scheduled to undergo laparoscopic gastrectomy in the reverse Trendelenburg position.
Interventions |
Patients were allocated to either the deep or moderate NMB group. The depth of NMB was maintained at a post-tetanic count of 1 for deep NMB with a continuous infusion of rocuronium and at a train-of-four count of 1 for moderate NMB with a small intermittent bolus of cisatracurium.
Measurements |
Single-blinded scoring of the quality of the surgical field condition was performed by a surgeon using a five-point scale in a 15-min interval during pneumoperitoneum. The quality of postoperative recovery was assessed using the Postoperative Quality of Recovery Scale (PostopQRS) on the day before surgery (baseline) and 1 h, 1 day, and 6 days after surgery.
Main results |
Optimal surgical field condition was rated in 87.0% (449/516) and 72.3% (370/512) of all measurements during deep and moderate NMB, respectively (P < 0.001). The percentage of patients maintaining a good-to-optimal condition throughout pneumoperitoneum was higher in the deep NMB group than in the moderate NMB group. There were no significant differences in the percentage of recovered patients between the two groups for all domains and all timepoints.
Conclusions |
Multiple assessments of the surgical field condition demonstrated that deep NMB provided a more satisfactory surgical field condition than moderate NMB during laparoscopic gastrectomy. However, the quality of postoperative recovery, assessed using the PostopQRS, was not different between the two groups according to the depth of NMB.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Deep neuromuscular blockade provided a more satisfactory surgical condition. |
• | Multiple measurements were used to evaluate the surgical condition during surgery. |
• | Multiple measurements may detect a difference of surgical condition sensitively. |
• | Postoperative recovery was assessed using postoperative quality of recovery scale. |
Keywords : Anesthesia, Neuromuscular block, Laparoscopy, Surgical rating scale, Postoperative recovery
Plan
Vol 73
Article 110338- octobre 2021 Retour au numéro
Article précédent
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