The Intraocular Pressure under Deep versus Moderate Neuromuscular Blockade during Low-Pressure Robot Assisted Laparoscopic Radical Prostatectomy in a Randomized Trial

Abstract

BackgroundThis study aimed to determine whether continuous deep neuromuscular blockade (NMB) improves the surgical conditions and facilitates robotic-assisted laparoscopic radical prostatectomy (RALRP) under low intra-abdominal pressure (IAP) to attenuate the increase in intraocular pressure (IOP) during CO2 pneumoperitoneum in the steep Trendelenburg (ST) position.MethodsSixty-seven patients undergoing RALRP were randomly assigned to a moderate NMB group (Group M), including patients who received atracurium infusion until the end of the ST position, maintaining a train of four count of 1–2; and the deep NMB group (Group D), including patients who received rocuronium infusion, maintaining a post-tetanic count of 1–2. IOP was measured in all patients at nine separate time points. All RALRPs were performed by one surgeon, who rated the overall and worst surgical conditions at the end of the ST position.ResultsThe highest IOP value was observed at T4 (60 min after the ST position) in both Group M (23.3 ± 2.7 mmHg) and Group D (19.8 ± 2.1 mmHg). RALRP was accomplished at an IAP of 8 mmHg in 88% Group D patients and 25% Group M patients. The overall surgical condition grade was 4.0 (3.0–5.0) in Group D and 3.0 (2.0–5.0) in Group M (P < 0.001).ConclusionThe current study demonstrated that continuous deep NMB may improve surgical conditions and facilitate RALRP at a low IAP, resulting in significant attenuation of the increase on IOP. Moreover, low-pressure pneumoperitoneum, facilitated by deep NMB still provided acceptable surgical conditions.Trial RegistrationClinicalTrials.gov NCT02109133

Deep Neuromuscular Block Improves Surgical Conditions during Bariatric Surgery and Reduces Postoperative Pain: A Randomized Double Blind Controlled Trial

“…Other independent investigators have used the L-SRS successfully in robotic laparoscopic prostate surgery and microlarynx surgery comparing deep versus moderate NMB [21,22]. In both of these studies the scorings during deep and moderate NMB were similar to those observed in our studies.…”

“…We developed a 5-point rating scale that has already been used in several studies [1,4,21,22]. Additionally, screening the US National Institutes of Health clinical registry (clinicaltrial.gov) showed that various ongoing trials also use the L-SRS (see for example, NCT02320734, NCT02601508 and NCT02888067).…”

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

“…condYoo [21]2015UrologyDeep versus moderate NMB5 point a 1 (extremely poor)–5 (optimal)1End of surgeryMean SRSBoon [7]2016UrologyDeep versus moderate NMB5 point a 1 (extremely poor)–5 (optimal)115 minMean SRS, % subopt./opt. condTorensma [4]2016Bariatric surgeryDeep versus moderate NMB5 point a 1 (extremely poor)–5 (optimal)310 minMean SRS, % subopt./opt.…”

Prospective evaluation of visual function in patients with ocular diseases after robot‐assisted laparoscopic prostatectomy

“…Recently, several prospective clinical studies have been carried out to evaluate the effects on visual function in patients undergoing RALP . However, most studies excluded patients with pre‐existing ocular diseases, and included healthy patients who were favorable for RALP.…”

“…3,4 Recently, several prospective clinical studies have been carried out to evaluate the effects on visual function in patients undergoing RALP. [5][6][7][8][9][10][11][12][13] However, most studies excluded patients with pre-existing ocular diseases, and included healthy patients who were favorable for RALP. Thus far, there has been no prospective assessment regarding RALP for patients with ocular diseases, except for a case report; a glaucomatous patient who underwent RALP without any severe ocular damage was reported on, and how to monitor and manage elevated IOP during RALP was described.…”