Optimized surgical space during low-pressure laparoscopy with deep neuromuscular blockade

TY - JOUR

T1 - Optimized surgical space during low-pressure laparoscopy with deep neuromuscular blockade

AU - Staehr-Rye, Anne K

AU - Rasmussen, Lars S

AU - Rosenberg, Jacob

AU - Juul, Poul

AU - Gätke, Mona R

PY - 2013

Y1 - 2013

N2 - Introduction: Laparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (< 12 mmHg), but surgical conditions may not be optimal. The present study aims at comparing surgical space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mmHg) LC. We hypothesise that a deep neuromuscular block will be associated with a higher proportion of optimal surgical space conditions. Material and methods: This is an investigator-initiated, patient- and assessor-blinded study. Up to 72 patients scheduled for elective LC are randomised to either deep neuromuscular blockade (post-tetanic count 0-1) or moderate neuromuscular blockade, where at least one response to train-of-four nerve stimulation is present. The primary outcome is surgical space conditions at the time during surgery when conditions are worst. The secondary outcomes include the proportion of procedures completed at pneumoperitoneum 8 mmHg, post-operative pain, and incidence of nausea and vomiting. Conclusion: This study is the first randomised study to assess the association between depth of neuromuscular blockade and surgical space conditions during low-pressure LC. The study findings may be applicable to a general surgical population undergoing LC. Funding: The University of Copenhagen, Denmark and Sophus Johansens Foundation of 1981, Denmark funds this study, which is also financed by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp.

AB - Introduction: Laparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (< 12 mmHg), but surgical conditions may not be optimal. The present study aims at comparing surgical space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mmHg) LC. We hypothesise that a deep neuromuscular block will be associated with a higher proportion of optimal surgical space conditions. Material and methods: This is an investigator-initiated, patient- and assessor-blinded study. Up to 72 patients scheduled for elective LC are randomised to either deep neuromuscular blockade (post-tetanic count 0-1) or moderate neuromuscular blockade, where at least one response to train-of-four nerve stimulation is present. The primary outcome is surgical space conditions at the time during surgery when conditions are worst. The secondary outcomes include the proportion of procedures completed at pneumoperitoneum 8 mmHg, post-operative pain, and incidence of nausea and vomiting. Conclusion: This study is the first randomised study to assess the association between depth of neuromuscular blockade and surgical space conditions during low-pressure LC. The study findings may be applicable to a general surgical population undergoing LC. Funding: The University of Copenhagen, Denmark and Sophus Johansens Foundation of 1981, Denmark funds this study, which is also financed by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp.

M3 - Journal article

SN - 2245-1919

VL - 60

SP - A4579

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 2

ER -