Randomized Clinical Trial of Moderate Versus Deep Neuromuscular Block for Low‐Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy

Koo, Bon Wook; Oh, Ah Young; Seo, Kangmoon; Han, Ji Won; Han, Ho‐Seong; Yoon, Yoo Seok

doi:10.1007/s00268-016-3633-8

Cited by 66 publications

(53 citation statements)

References 29 publications

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“…We were unable to demonstrate a reduction in the duration of surgery. This is in contrast to our previous study, which showed a significant decrease in the duration of operations with deep compared with moderate neuromuscular block during laparoscopic cholecystectomy .…”

Section: Discussioncontrasting

confidence: 99%

Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial

Koo

et al. 2018

Anaesthesia

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There have been few objective evaluations of the effects of deep neuromuscular blockade on intra-operative conditions. In this prospective randomised controlled study, we evaluated the effects of deep neuromuscular block on surgical conditions during laparoscopic colorectal surgery. Patients were randomly allocated using a computer-generated randomisation code to either moderate (train-of-four count 1-2 maintained and antagonised with neostigmine) or deep (post-tetanic count 1-2 maintained and reversed with sugammadex) levels of neuromuscular blockade. The primary outcome measure was the number of abrupt increases in intra-abdominal pressure intra-operatively. Secondary outcome variables were intra-operative restoration of spontaneous breathing, number of surgical requests for additional neuromuscular blockade, surgical rating of operating conditions and patient satisfaction. The surgeon who rated the surgical conditions score and investigator who checked the postoperative variables were blinded to patient allocation. In total, we recruited 70 patients of whom 64 (32 in each group) were analysed. Increases in intra-abdominal pressure (14/32 vs. 6/32; p = 0.031), intra-operative restoration of spontaneous breathing (16/32 vs. 2/32; p < 0.001) and request for additional neuromuscular blockade (21/32 vs. 8/32; p = 0.001) were more frequent in the moderate compared with the deep group. In patients undergoing elective laparoscopic colorectal surgery, deep neuromuscular blockade provided better surgical conditions than moderate neuromuscular blockade, as measured by a reduction in the incidence of intra-abdominal pressure alarms.

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Section: Discussioncontrasting

confidence: 99%

Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial

Koo

et al. 2018

Anaesthesia

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“…3 changes from 46 to 0% when removing the study of Staehr-Rye and colleagues 6 from the meta-analysis. A possible explanation could be that only the studies by Kim and colleagues, 1 Koo and colleagues, 5 and Staehr-Rye and colleagues 6 used low-pressure pneumoperitoneum. Kim and colleagues 1 decreased the IAP from standard pressure (1.6 kPa) without compromising the surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis

Bruintjes

Helden

Braat

et al. 2017

British Journal of Anaesthesia

166

114

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Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. We performed a systematic review and meta-analysis of studies comparing the influence of deep vs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes. Trials were identified from Medline, Embase, and Central databases from inception to December 2016. We included randomized trials, crossover studies, and cohort studies. Our search yielded 12 studies on the effect of deep NMB on the surgical space conditions. Deep NMB during laparoscopic surgeries improves the surgical space conditions when compared with moderate NMB, with a mean difference of 0.65 (95% confidence interval (CI): 0.47-0.83) on a scale of 1-5, and it facilitates the use of low-pressure pneumoperitoneum. Furthermore, deep NMB reduces postoperative pain scores in the postanaesthesia care unit, with a mean difference of - 0.52 (95% CI: -0.71 to - 0.32). Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit. Whether this leads to fewer intraoperative complications, an improved quality of recovery, or both after laparoscopic surgery should be pursued in future studies. The review methodology was specified in advance and registered at Prospero on July 27, 2016, registration number CRD42016042144.

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“…Some only reported the percentage of unacceptable surgical conditions, which was generally the frequency of scores on the lower half of the surgical rating scale [3, 17, 20]. In addition, the number and moments of scoring differed considerably, with some studies scoring every 10 or 15 min [1, 2, 4, 7, 19, 20], while others scored one overall score at the end of surgery [3, 5, 8, 15, 17, 18, 21]. Some reports do not mention a scoring interval at all [16, 24].…”

Section: Resultsmentioning

confidence: 99%

“…Some reports do not mention a scoring interval at all [16, 24]. In addition to the surgical rating scale, some have assessed other outcomes as well such as intra-abdominal space and the effect on insufflation pressures (see Table 4) [6, 15, 17, 20]. …”

Section: Resultsmentioning

confidence: 99%

The use of surgical rating scales for the evaluation of surgical working conditions during laparoscopic surgery: a scoping review

et al. 2018

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Randomized Clinical Trial of Moderate Versus Deep Neuromuscular Block for Low‐Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy

Cited by 66 publications

References 29 publications

Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial

Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial

Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis

The use of surgical rating scales for the evaluation of surgical working conditions during laparoscopic surgery: a scoping review

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