Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block

The routine use of neuromuscular blocking agents reduces the occurrence of unacceptable surgical conditions. In some surgeries, such as retroperitoneal laparoscopies, deep neuromuscular block (NMB) may further improve surgical conditions compared with moderate NMB. In this study, the effect of deep...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 2014-03, Vol.112 (3), p.498-505
Main Authors: Martini, C.H., Boon, M., Bevers, R.F., Aarts, L.P., Dahan, A.
Format: Article
Language:English
Subjects:
Adult
Aged
Androstanols - administration & dosage
Androstanols - antagonists & inhibitors
Anesthesia, Intravenous
Anesthetics, Intravenous
Consciousness Monitors
Data Interpretation, Statistical
Electric Stimulation
Electromyography
Endpoint Determination
gamma-Cyclodextrins
Hemodynamics
Humans
Isoquinolines - administration & dosage
Isoquinolines - antagonists & inhibitors
Laparoscopy
Middle Aged
Monitoring, Intraoperative
Muscle Contraction - physiology
nephrectomy
neuromuscular block
Neuromuscular Blockade
Neuromuscular Blocking Agents - antagonists & inhibitors
Neuromuscular Nondepolarizing Agents - administration & dosage
Neuromuscular Nondepolarizing Agents - antagonists & inhibitors
Propofol
prostatectomy
rocuronium
Sample Size
Sufentanil
sugammadex
urological surgical procedures
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Summary:The routine use of neuromuscular blocking agents reduces the occurrence of unacceptable surgical conditions. In some surgeries, such as retroperitoneal laparoscopies, deep neuromuscular block (NMB) may further improve surgical conditions compared with moderate NMB. In this study, the effect of deep NMB on surgical conditions was assessed. Twenty-four patients undergoing elective laparoscopic surgery for prostatectomy or nephrectomy were randomized to receive moderate NMB (train-of-four 1–2) using the combination of atracurium/mivacurium, or deep NMB (post-tetanic count 1–2) using high-dose rocuronium. After surgery, NMB was antagonized with neostigmine (moderate NMB), or sugammadex (deep NMB). During all surgeries, one surgeon scored the quality of surgical conditions using a five-point surgical rating scale (SRS) ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Video images were obtained and 12 anaesthetists rated a random selection of images. Mean (standard deviation) SRS was 4.0 (0.4) during moderate and 4.7 (0.4) during deep NMB (P
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/aet377