Depth of neuromuscular blockade and the perioperative conditions in laparoscopic surgery in pediatric population: Randomized controlled pilot trial

Klučka, Jozef; Szturzová, Kateřina; Kosinová, Martina; Knoppová, Lenka; Ťoukalková, Michaela; Štoudek, Roman; Kratochvíl, Milan; Trčková, Alena; Klincová, Martina; Kovalčíková, Petra; Pavlík, Tomáš; Plánka, Ladislav; Tůma, Jiří; Štourač, Petr

doi:10.1016/j.jclinane.2019.109659

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…1 , PRISMA study selection flow chart), 22 papers were included in the review ( Table 4 ). We identified 12 that used propofol as primary anaesthetic agent, 6 , 10 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 of which six found a benefit of deep neuromuscular block on surgical working conditions, 6 , 10 , 19 , 25 , 26 , 27 and six did not. 28 , 29 , 30 , 31 , 32 , 33 In addition, 10 studies were identified that used an inhalation agent.…”

Section: Resultsmentioning

confidence: 99%

“…We identified 12 that used propofol as primary anaesthetic agent, 6 , 10 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 of which six found a benefit of deep neuromuscular block on surgical working conditions, 6 , 10 , 19 , 25 , 26 , 27 and six did not. 28 , 29 , 30 , 31 , 32 , 33 In addition, 10 studies were identified that used an inhalation agent. 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 Seven out of these 10 studies reported a benefit of deep neuromuscular block during inhalation anaesthesia on surgical working conditions.…”

Section: Resultsmentioning

confidence: 99%

“…Our systematic review identified 12 studies that used propofol as a primary anaesthetic, of which half found a benefit of deep neuromuscular block, 6 , 10 , 19 , 25 , 26 , 27 whereas the other half did not ( Table 4 ). 28 , 29 , 30 , 31 , 32 , 33 Significant methodological differences and the large heterogeneity in surgical procedures prevents drawing definitive conclusions from these studies. However, the results of our current (sevoflurane) and previous (propofol) studies 6 , 7 give an indication of the differential effects of propofol and sevoflurane on surgical working conditions in laparoscopic renal surgery.…”

Section: Discussionmentioning

confidence: 99%

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Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery

Honing

Martini

Olofsen

et al. 2021

British Journal of Anaesthesia

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Background Deep neuromuscular block is associated with improved working conditions during laparoscopic surgery when propofol is used as a general anaesthetic. However, whether deep neuromuscular block yields similar beneficial effects when anaesthesia is maintained using volatile inhalation anaesthesia has not been systematically investigated. Volatile anaesthetics, as opposed to intravenous agents, potentiate muscle relaxation, which potentially reduces the need for deep neuromuscular block to obtain optimal surgical conditions. We examined whether deep neuromuscular block improves surgical conditions over moderate neuromuscular block during sevoflurane anaesthesia. Methods In this single-centre, prospective, randomised, double-blind study, 98 patients scheduled for elective renal surgery were randomised to receive deep (post-tetanic count 1–2 twitches) or a moderate neuromuscular block (train-of-four 1–2 twitches). Anaesthesia was maintained with sevoflurane and titrated to bispectral index values between 40 and 50. Pneumoperitoneum pressure was maintained at 12 mm Hg. The primary outcome was the difference in surgical conditions, scored at 15 min intervals by one of eight blinded surgeons using a 5-point Leiden-Surgical Rating Scale (L-SRS) that scores the quality of the surgical field from extremely poor 1 to optimal 5 . Results Deep neuromuscular block did not improve surgical conditions compared with moderate neuromuscular block: mean (standard deviation) L-SRS 4.8 (0.3) vs 4.8 (0.4), respectively ( P =0.94). Secondary outcomes, including unplanned postoperative readmissions and prolonged hospital admission, were not significantly different. Conclusions During sevoflurane anaesthesia, deep neuromuscular block did not improve surgical conditions over moderate neuromuscular block in normal-pressure laparoscopic renal surgery. Clinical trial registration NL7844 ( www.trialregister.nl ).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery

Honing

Martini

Olofsen

et al. 2021

British Journal of Anaesthesia

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“…Our previous study, using a laryngeal mask airway in short-duration paediatric laparoscopic surgery, showed that moderate NMB significantly improved surgical conditions compared with no NMB 2 . Another study showed that deep NMB had no benefit over moderate NMB regarding the surgical conditions for laparoscopic surgery in children aged 2 to 18 years 6 . However, none of these data refer to neonates and small infants.…”

Section: Introductionmentioning

confidence: 99%

“…2 Another study showed that deep NMB had no benefit over moderate NMB regarding the surgical conditions for laparoscopic surgery in children aged 2 to 18 years. 6 However, none of these data refer to neonates and small infants. In clinical practice, anaesthesiologists are relatively conservative in the use of NMB in neonates and small infants for fear of complications associated with residual neuromuscular block (RNB).…”

Section: Introductionmentioning

confidence: 99%

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Wu,

Wei,

Xiang

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Neuromuscular block (NMB) is routinely used in paediatric and adult anaesthesia to facilitate endotracheal intubation and optimise surgical conditions. However, there are limited data regarding NMB and optimising the conditions for laparoscopic surgery in neonates and small infants. OBJECTIVE The goal of this study was to determine the effect of NMB on the conditions for laparoscopic surgery in neonates and small infants. DESIGN A randomised controlled trial. SETTING Single-centre Children's Hospital, conducted from November 2021 to December 2022. PATIENTS One hundred and two ASA I–II neonates and small infants aged up to 60 weeks postmenstrual age who were scheduled to undergo an elective laparoscopic Ladd's procedure were included in the study. INTERVENTIONS Patients were randomised into three groups: no NMB group, shallow NMB group and moderate NMB group. Each group was given different doses of rocuronium to achieve the target depth of NMB. MAIN OUTCOME MEASURES The primary outcome was the quality of the surgical conditions evaluated with the Leiden-Surgical Rating Scale (L-SRS) by a blinded surgeon. Secondary outcomes included tracheal intubating conditions and adverse events. RESULTS The percentage of L-SRS scores of 4 or 5 was similar among the three groups at all the assessment times (P > 0.05 for each time interval). The distribution of L-SRS scores was also similar among the three groups. There were no significant differences in operating condition scores between the groups at any time interval (P > 0.05 for each time interval). The incidence of adverse events during anaesthesia induction was significantly higher in the no NMB group (51.4%) than in the other two groups (13.6% and 14.7%) (adjusted P = 0.012 and adjusted P = 0.003). In particular, clinically unacceptable intubation conditions occurred in 12 patients (34.3%) in the no NMB group, significantly more than in the shallow NMB group (6.1%, adjusted P = 0.012) and moderate NMB group (2.9%, adjusted P = 0.003). There was no statistically significant difference in the incidence of adverse events in the PACU among the three groups (P = 0.103). CONCLUSIONS The depth of NMB was not associated with superior surgical conditions during laparoscopic surgery, but it was associated with a reduction in adverse events during induction and maintenance of anaesthesia in neonates and small infants. TRIAL REGISTRATION Registered at www.chictr.org.cn (ChiCTR2100052296).

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Deep neuromuscular blockade in adults undergoing an abdominal laparoscopic procedure

Bijkerk,

Jacobs,

Albers

et al. 2024

Cochrane Database of Systematic Reviews

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Depth of neuromuscular blockade and the perioperative conditions in laparoscopic surgery in pediatric population: Randomized controlled pilot trial

Cited by 3 publications

References 5 publications

Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery

Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Deep neuromuscular blockade in adults undergoing an abdominal laparoscopic procedure

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