Randomized Clinical Trial of Moderate Versus Deep Neuromuscular Block for Low-Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy
- Authors
- Koo, Bon-Wook; Oh, Ah-Young; Seo, Kwang-Suk; Han, Ji-Won; Han, Ho-Seong; Yoon, Yoo-Seok
- Issue Date
- Dec-2016
- Publisher
- SPRINGER
- Citation
- WORLD JOURNAL OF SURGERY, v.40, no.12, pp 2898 - 2903
- Pages
- 6
- Journal Title
- WORLD JOURNAL OF SURGERY
- Volume
- 40
- Number
- 12
- Start Page
- 2898
- End Page
- 2903
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/74410
- DOI
- 10.1007/s00268-016-3633-8
- ISSN
- 0364-2313
1432-2323
- Abstract
- The beneficial effects of deep blockade are not fully known. In this study, we evaluated the effect of deep neuromuscular blockade on surgical conditions during laparoscopic cholecystectomy under low-pressure pneumoperitoneum. Patients undergoing elective laparoscopic cholecystectomy were randomized to either the moderate group (train-of-four count of 1 or 2) or deep group (posttetanic count of 1 or 2). Neuromuscular blockade was induced and maintained with rocuronium; it was reversed with sugammadex in the deep group and with neostigmine in the moderate group. At the beginning of surgery, the intra-abdominal pressure was set at 8 mmHg. The surgeon rated the surgical condition on a 4-point scale (1 = excellent, 2 = good, 3 = acceptable, 4 = poor) and was allowed to increase the pressure to 12 mmHg if it was determined that the surgical conditions were inadequate for the operation. A total of 64 patients completed the study. The rate of increasing intra-abdominal pressure to maintain optimal surgical conditions was 34.4 % in the moderate group and 12.5 % in the deep group (P = 0.039). The proportion of patients with a surgical condition score of 1 or 2 (excellent or good) was 34.4 % in the moderate group and 68.8 % in the deep group (P = 0.006). The maintenance of intraoperative deep neuromuscular blockade was associated with a lower rate of conversion to standard pressure and higher surgeon satisfaction with the surgical conditions than was moderate blockade in patients undergoing low-pressure pneumoperitoneum laparoscopic cholecystectomy.
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