Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy

Matias Vested Madsen; Olav Istre; Henrik Halvor Springborg; Anne Kathrine Staehr-Rye; Jacob Rosenberg; Jørgen Lund; Mona Ring Gätke

Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy

Matias Vested Madsen^*, Olav Istre, Henrik Halvor Springborg, Anne Kathrine Staehr-Rye, Jacob Rosenberg, Jørgen Lund, Mona Ring Gätke

^*Corresponding author for this work

Department of Clinical Medicine

7 Citations (Scopus)

1 Downloads (Pure)

Abstract

Introduction: Establishment of sufficient muscle relaxation is essential in laparoscopic surgery. During laparoscopy, surgeons can experience abdominal contractions in their patients. Deep neuromuscular block (NMB) has the potential to prevent such episodes. In this study, we explored if deep NMB reduces the incidence of sudden abdominal contractions as compared with standard NMB. Methods: This was a pre-planned secondary analysis of a randomized, controlled study. A total of 110 patients scheduled for laparoscopic hysterectomy were randomized to either deep NMB and 8 mmHg pneumoperitoneum (deep NMB group) or single-bolus NMB and 12 mmHg pneumoperitoneum (standard NMB group). NMB was established with rocuronium and reversed with sugammadex. Two gynaecologists registered episodes of sudden abdominal contractions, alarms from the insufflator due to increased intra-abdominal pressure and incidences with tightness of the abdominal wall. Results: No sudden abdominal contractions were detected in the deep NMB group as compared with 12 episodes in the standard NMB group (p < 0.001). The insufflator alarmed in no versus ten procedures (p = 0.001) in the deep and standard NMB group, respectively. The gynaecologists registered increasing abdominal tensions in no versus eight procedures (p = 0.006) in the deep and standard NMB group, respectively. Conclusion: Deep NMB in combination with 8 mmHg pneumoperitoneum prevented sudden abdominal contractions during laparoscopic hysterectomy.

Original language	English
Article number	A5364
Journal	Danish Medical Journal
Volume	64
Issue number	5
ISSN	1603-9629
Publication status	Published - May 2017

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@article{f53e56a933794bdd83c28b64643b6327,

title = "Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy",

abstract = "Introduction: Establishment of sufficient muscle relaxation is essential in laparoscopic surgery. During laparoscopy, surgeons can experience abdominal contractions in their patients. Deep neuromuscular block (NMB) has the potential to prevent such episodes. In this study, we explored if deep NMB reduces the incidence of sudden abdominal contractions as compared with standard NMB. Methods: This was a pre-planned secondary analysis of a randomized, controlled study. A total of 110 patients scheduled for laparoscopic hysterectomy were randomized to either deep NMB and 8 mmHg pneumoperitoneum (deep NMB group) or single-bolus NMB and 12 mmHg pneumoperitoneum (standard NMB group). NMB was established with rocuronium and reversed with sugammadex. Two gynaecologists registered episodes of sudden abdominal contractions, alarms from the insufflator due to increased intra-abdominal pressure and incidences with tightness of the abdominal wall. Results: No sudden abdominal contractions were detected in the deep NMB group as compared with 12 episodes in the standard NMB group (p < 0.001). The insufflator alarmed in no versus ten procedures (p = 0.001) in the deep and standard NMB group, respectively. The gynaecologists registered increasing abdominal tensions in no versus eight procedures (p = 0.006) in the deep and standard NMB group, respectively. Conclusion: Deep NMB in combination with 8 mmHg pneumoperitoneum prevented sudden abdominal contractions during laparoscopic hysterectomy.",

author = "Madsen, {Matias Vested} and Olav Istre and Springborg, {Henrik Halvor} and Staehr-Rye, {Anne Kathrine} and Jacob Rosenberg and J{\o}rgen Lund and G{\"a}tke, {Mona Ring}",

year = "2017",

month = may,

language = "English",

volume = "64",

journal = "Danish Medical Journal",

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T1 - Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy

AU - Madsen, Matias Vested

AU - Istre, Olav

AU - Springborg, Henrik Halvor

AU - Staehr-Rye, Anne Kathrine

AU - Rosenberg, Jacob

AU - Lund, Jørgen

AU - Gätke, Mona Ring

PY - 2017/5

Y1 - 2017/5

N2 - Introduction: Establishment of sufficient muscle relaxation is essential in laparoscopic surgery. During laparoscopy, surgeons can experience abdominal contractions in their patients. Deep neuromuscular block (NMB) has the potential to prevent such episodes. In this study, we explored if deep NMB reduces the incidence of sudden abdominal contractions as compared with standard NMB. Methods: This was a pre-planned secondary analysis of a randomized, controlled study. A total of 110 patients scheduled for laparoscopic hysterectomy were randomized to either deep NMB and 8 mmHg pneumoperitoneum (deep NMB group) or single-bolus NMB and 12 mmHg pneumoperitoneum (standard NMB group). NMB was established with rocuronium and reversed with sugammadex. Two gynaecologists registered episodes of sudden abdominal contractions, alarms from the insufflator due to increased intra-abdominal pressure and incidences with tightness of the abdominal wall. Results: No sudden abdominal contractions were detected in the deep NMB group as compared with 12 episodes in the standard NMB group (p < 0.001). The insufflator alarmed in no versus ten procedures (p = 0.001) in the deep and standard NMB group, respectively. The gynaecologists registered increasing abdominal tensions in no versus eight procedures (p = 0.006) in the deep and standard NMB group, respectively. Conclusion: Deep NMB in combination with 8 mmHg pneumoperitoneum prevented sudden abdominal contractions during laparoscopic hysterectomy.

AB - Introduction: Establishment of sufficient muscle relaxation is essential in laparoscopic surgery. During laparoscopy, surgeons can experience abdominal contractions in their patients. Deep neuromuscular block (NMB) has the potential to prevent such episodes. In this study, we explored if deep NMB reduces the incidence of sudden abdominal contractions as compared with standard NMB. Methods: This was a pre-planned secondary analysis of a randomized, controlled study. A total of 110 patients scheduled for laparoscopic hysterectomy were randomized to either deep NMB and 8 mmHg pneumoperitoneum (deep NMB group) or single-bolus NMB and 12 mmHg pneumoperitoneum (standard NMB group). NMB was established with rocuronium and reversed with sugammadex. Two gynaecologists registered episodes of sudden abdominal contractions, alarms from the insufflator due to increased intra-abdominal pressure and incidences with tightness of the abdominal wall. Results: No sudden abdominal contractions were detected in the deep NMB group as compared with 12 episodes in the standard NMB group (p < 0.001). The insufflator alarmed in no versus ten procedures (p = 0.001) in the deep and standard NMB group, respectively. The gynaecologists registered increasing abdominal tensions in no versus eight procedures (p = 0.006) in the deep and standard NMB group, respectively. Conclusion: Deep NMB in combination with 8 mmHg pneumoperitoneum prevented sudden abdominal contractions during laparoscopic hysterectomy.

M3 - Journal article

C2 - 28552090

AN - SCOPUS:85020700711

SN - 2245-1919

VL - 64

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 5

M1 - A5364

ER -

Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy

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