Effect of Neuromuscular Blockade on Intraoperative Respiratory Mechanics and Surgical Space Conditions during Robot-Assisted Radical Prostatectomy: A Prospective Randomized Controlled Trial

Abstract

The aim of this study was to investigate whether deep neuromuscular blockade (NMB) may affect intraoperative respiratory mechanics, surgical condition, and recovery profiles in patients undergoing robot-assisted radical prostatectomy (RARP). Patients were randomly assigned to the moderate or deep NMB groups. Pneumoperitoneum was maintained with carbon dioxide (CO2) insufflation at 15 mmHg during surgery. The primary outcome was peak inspiratory pressure (PIP) after CO2 insufflation. Mean airway pressure (Pmean) and dynamic lung compliance (Cdyn) were also recorded. The surgeon rated the surgical condition and surgical difficulty on a five-point scale (1 = extremely poor; 2 = poor; 3 = acceptable; 4 = good; 5 = optimal). Recovery profiles, such as pulmonary complications, pain scores, and recovery time, were recorded. We included 58 patients in this study. No significant differences were observed regarding intraoperative respiratory mechanics including PIP, Pmean and Cdyn, between the two groups. The number of patients with optimal surgical conditions was significantly higher in the deep than in the moderate NMB group (29 vs. 20, p = 0.014). We found no differences in recovery profiles. In conclusion, deep NMB had no significant effect on the intraoperative respiratory mechanics but resulted in optimal endoscopic surgical conditions during RARP compared with moderate NMB.

Effects of Deep Neuromuscular Block during Robot-Assisted Transaxillary Thyroidectomy: A Randomized Controlled Trial

“…According to a meta-analysis [11] on the effects of deep NMB in laparoscopic abdominal surgery, it was proven that deep NMB reduces early postoperative pain and improves the surgical condition during laparoscopic abdominal surgery. Additionally, two randomized, controlled trials [25,26] reported that deep NMB improves surgical condition during robot-assisted radical prostatectomy. However, to our knowledge, there has been no study that investigated the effect of deep NMB in RATT.…”

Does deep neuromuscular blockade provide improved perioperative outcomes in adult patients? A systematic review and meta-analysis of randomized controlled trials

“…Seven studies were judged to be at low risk of bias [17,23,26,28,31,40,53], 23 studies were judged to raise some concerns [12, 15, 16, 19, 24, 29, 32, 34, 36, 38, 41-47, 49-52, 54, 55], and 10 studies were judged to be at high risk of bias [13,14,25,27,30,33,35,37,39,48]. The details of judgments for each risk-of-bias domain are demonstrated in Fig 2.…”

“…Adverse events. Twenty-one studies reported specific perioperative adverse events, which included but were not limited to vascular and organ injury [39,44,49], respiratory complications [14,23,34,35,39,40], cardiovascular complications, digestive complications [34], postoperative nausea and vomiting [17,30,31,33,38,40,41,44,48,50,52,53], incision complications [46], postoperative delirium [17], and shoulder pain [27,38,47]. The sample size was small, and the adverse events varied.…”

“…The difference was not significant in either the MNMB, non-MNMB, or inhalational anesthesia Intraoperative blood loss. Five studies examined the intraoperative blood loss in 329 patients [16,33,35,40,54]. The pooled mean intraoperative blood loss was 195.7±220.9 mL in the DNMB group and 242.6±280.6 mL in the non-DNMB group.…”

“…In terms of the risk of bias, there were few studies at low risk of bias (7 RCTs, 17.5%) [17,23,26,28,31,40,53]. Some studies were judged to have some concerns about the risk of bias (23 RCTs, 57.1%) [12, 15, 16, 19, 24, 29, 32, 34, 36, 38, 41-47, 49-52, 54, 55].…”