Background There is high incidence of postoperative residual curarization(PORC)in elderly patients. Ionised calcium plays a significant role in the neuromuscular junction. Objective to investigate the effect of using different doses of calcium gluconate on residual neuromuscular blockade༈NMB༉after laparoscopy in elderly patients, and also to observe its clinical safety and dose-effect relationship. Methods One hundred and eighty elderly patients who underwent elective laparoscopic surgery were randomly divided into four groups, the experimental group of 5 mg/kg, 10 mg/kg, 20 mg/kg calcium gluconate injection combined with neostigmine (C5 group, C10 group, C20 group) and the neostigmine group (N group), 45 cases in each group. At the end of the operation, when TOFc(train-of-four count) was ≥ 3, patients received 40 ug/kg neostigmine with 20 ug/kg atropine intravenously, while C5, C10, and C20 group received additional calcium gluconate 5 or 10 or 20 mg/kg. The time of TOFr (T4 /T1 ) ≥ 0.90 and the incidence of PORC at 5, 10, 15 and 20 minutes after neostigmine administration were observed in the four groups. Results The time of TOFr ≥ 0.90 was 11.50 (9.25,14.75) min in the control group, 7.50 (6.00,9.00) min in the C5 group, 9.50 (8.00,12.00) min in the C10 group and 10.00 (9.00,12.00) min in the C20 group (P<0.001). The incidence of PORC after extubation was 27 (67.5%) in N group, 21 (52.5%) in C5 group 12 (30%) in C10 group and 7 (17.5%) in C20 group (P<0.001). There were no differences between the four groups with respect to the incidence of PORC at 5 and 15min after administration of neostigmine. Conclusions Calcium gluconate can be safely used for promoting early postoperative NMB recovery of cis-atracurium in elderly patients, and the recovery process was more stable in the C20 group.
Objective To investigate the effect of applying pressure-controlled ventalition and volume-guaranteed (PCV-VG) ventilation on intraoperative respiratory mechanics and pulmonary function in patients in the Trendelenburg position during robot-assisted laparoscopic surgery. Methods Seventy-six patients who underwent robotic-assisted laparoscopic Trendelenburg position from April 2021 to May 2022 at the Affiliated Hospital of Xuzhou Medical University were selected and divided into PCV-VG group (group P ) and VCV group (group V ) using the random number table method. Observed indexes: intraoperative respiratory mechanics parameters such as peak airway pressure (Ppeak ), plateau pressure (Pplat ), pulmonary dynamic compliance (Cdyn), airway resistance(Raw). Respiratory function parameters: SpO2 , PaO2 , PaCO2 , SaO2 and calculate the oxygenation index (OI), alveolar-arterial oxygen partial pressure difference (PA-a DO2 ), intrapulmonary shunt (Qs /Qt ), respiratory index (RI); intraoperative hemodynamic index and postoperative complications. Results Compared with VCV, PCV-VG, a new ventilation mode, can better ensure the mechanical ventilation effect in patients with prolonged robotic head-down position without affecting hemodynamics, reduce peak airway pressure and plateau pressure, increase dynamic lung compliance, and optimize intraoperative respiratory function in pneumoperitoneum and Trendelenburg position patients with Trendelenburg position duration over 2h.Conclusion: Compared to VCV, PCV-VG provided lower Ppeak with Pplat and improved Cdyn during robot-assisted laparoscopic Trendelenburg position surgery, better pulmonary oxygenation and gas exchange after pneumoperitoneum duration beyond 2h,better quality of recovery at 24h postoperatively. while there was no significant difference in hemodynamic variables.
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