Effect of neuromuscular block on surgical conditions during short-duration paediatric laparoscopic surgery involving a supraglottic airway

Abstract

Background: Use of an LMA ProSeal™ laryngeal mask airway (P-LMA; Teleflex) with no neuromuscular block is considered a safe alternative to tracheal intubation in short-duration paediatric laparoscopic surgery. However, few studies have evaluated surgical conditions of short-duration paediatric laparoscopic surgery using this anaesthetic technique. We assessed surgical conditions for paediatric laparoscopic inguinal hernia repair using P-LMA with and without neuromuscular block. Methods: Sixty-six patients undergoing laparoscopic inguinal hernia repair were randomised to receive a neuromuscular block (train-of-four 1e2 twitches) using rocuronium or no neuromuscular block with the P-LMA. All operations were performed by the same surgeon who determined the surgical conditions using the Leiden-surgical rating scale (L-SRS). Secondary outcomes included perioperative data, haemodynamics, and adverse events. Results: Neuromuscular block improved surgical conditions compared with no neuromuscular block: mean (standard deviation) L-SRS 4.1 (0.5) vs 3.5 (0.6), respectively (P<0.0001). Mean rocuronium dose in the neuromuscular block group was 12.7 (4.4e29.7) mg or 0.7 (0.6e0.8) mg kg À1 . The insufflation Ppeak was higher in the no neuromuscular block group than in the neuromuscular block group: mean (standard deviation) Ppeak 17.9 (1.8) cm H 2 O vs 16.2 (1.9) cm H 2 O, respectively (P¼0.0004). Fifteen children (45.5%) in the no neuromuscular block group had adverse events during the surgery and anaesthesia vs four children (12.1%) in the neuromuscular block group (P¼0.006). Conclusions: Neuromuscular block significantly improved surgical conditions and reduced the incidence of adverse events during surgery and anaesthesia when an LMA Proseal™ was used in short-duration paediatric laparoscopic surgery. Clinical trial registration: ChiCTR2000038529.

Comparison of 3 Rates for the Continuous Infusion of Mivacurium During Ambulatory Vitreoretinal Surgery Under General Anesthesia: A Prospective, Randomized, Controlled Clinical Trial

“…Recently, moderate neuromuscular block (TOFc = 1–2) has been reported to improve surgical conditions and reduce the incidence of adverse events in short-duration pediatric laparoscopic surgery with LMA. 28 Whether LMA ventilation and moderate muscle relaxation are suitable for vitreoretinal surgery has not been reported.…”

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

“…In adults, deep NMB improves the surgical space during laparoscopic surgery 19 . Our previous study showed that moderate NMB significantly improved conditions for short-duration laparoscopic surgery in children compared with no NMB 2 . However, there are limited data regarding NMB optimising the conditions for laparoscopic surgery in neonates and small infants.…”

“…In addition, the mean score for the surgical conditions during the laparoscopic surgery reached more than 4 points and the percentage of L-SRS scores of 4 or 5 reached 88% without NMB. The main reason for this result may be immature abdominal wall muscles and weak muscle tension in neonates and small infants 2,20 . Second, the potentiation of NMB and the central neuromuscular effects of volatile anaesthetics may also be an important reason for this result 14,21–23 …”

“…There are few studies involving neuromuscular blocking agents and the optimisation of conditions for laparoscopic surgery in children. 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 .…”

“…Neuromuscular block (NMB) is routinely used in paediatric anaesthesia to facilitate endotracheal intubation and optimise surgical conditions 1,2 . Recent studies have demonstrated the advantages of deep NMB in optimising the conditions for laparoscopic surgery in adults 3–5 .…”