Deep neuromuscular block improves surgical conditions during laparoscopic hysterectomy

Dubois, Philippe; Putz, Laurie; Jamart, Jacques; Marotta, Maria-Laura; Gourdin, Maximilien; Donnez, Olivier

doi:10.1097/eja.0000000000000094

Cited by 109 publications

(104 citation statements)

References 25 publications

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“…It also enables anaesthetists to keep patients paralyzed throughout the anaesthetic, thus facilitating surgery. This opinion not just was expressed by anaesthetists in our survey but has also been reported in 2 prospective trials [16, 17]. …”

Section: Discussionsupporting

confidence: 74%

Current Trends in Neuromuscular Blockade, Management, and Monitoring amongst Singaporean Anaesthetists

Teoh¹,

Ledowski

Tseng³

2016

Anesthesiology Research and Practice

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Introduction. This survey aimed to investigate the attitudes/practice pertaining the use, management, and monitoring of neuromuscular blockade amongst Singaporean anaesthetists. Methods. All specialist accredited anaesthetists registered with the Singapore Medical Council were invited to complete an anonymous online survey. Results. The response rate was 39.5%. Neuromuscular monitoring (NM) was used routinely by only 13.1% despite the widespread availability of monitors. 82% stated residual NMB (RNMB) was a significant risk factor for patient outcome, but only 24% believed NMB monitoring should be compulsory in all paralyzed patients. 63.6% of anaesthetists estimated the risk of RNMB in their own institutions to be <5%. 63.1% always gave reversal. Neostigmine was predominantly used (85.1%), with 28.2% using sugammadex at least sometimes, citing unavailability and high costs. However, 83.8% believed in sugammadex's benefits for patients' safety and >50% said such benefits may be able to offset the associated costs. Conclusions. There is a significant need for reeducation about RNMB, studies on local RNMB incidences, and strengthening of current monitoring practices and guidelines. Strategies are discussed. As NM monitors appear widely available and reversal of NMB standard practice, it is hopeful that Singaporean anaesthetists will change and strive for evidence-based best clinical practice to enhance patient safety.

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Section: Discussionsupporting

confidence: 74%

Current Trends in Neuromuscular Blockade, Management, and Monitoring amongst Singaporean Anaesthetists

Teoh¹,

Ledowski

Tseng³

2016

Anesthesiology Research and Practice

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“…Although others have used surgical rating scales [18–20], there is no gold standard on how to rate surgical conditions during laraproscopic surgery. We developed a 5-point rating scale that has already been used in several studies [1,4,21,22].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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BackgroundIt remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain.Methods and ResultsOne hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2–3) or a moderate NMB (train-of-four 1–2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0–4.4) versus 4.8 (4.7–4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1–3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4–5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2–4.9) versus 3.9 (3.6–4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5–2.1) versus 1.3 (1.1–1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001).ConclusionsIn bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.

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“…3) Case scenario 3: A laparoscopic hysterectomy takes on average 70 min when performed under deep NMB and reversed with sugammadex [104]. In an 8 h OR schedule (480 min) and assuming 30 min of turnover between two laparoscopic hysterectomies, 4.8 cases could be performed using sugammadex (total OR working hour/ laparoscopic hysterectomy performed under deep NMB reversed using sugammadex + min for turnover=480/70+30=4.8).…”

Section: Economic Evaluation In Real Clinical Scenariomentioning

confidence: 99%

A Short Update on Sugammadex with a Special Focus on Economic Assessment of its Use in North America

Zaouter¹,

Mion²,

Palomba³

et al. 2017

J Anesth Clin Res

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Sugammadex offers significant advantages over the current anticholinesterase reversal drugs. Sugammadex used has been approved for the United Stated and for Canada since December 2015 and February 2016, respectively. The present article aims to provide a straightforward and concise review of the most recent literature describing its clinical advantages in routine use. A thorough and cost-effective evaluation has been conducted specifically for North America to determine if its price justifies its inclusion into regular patients' care. The search examined the relevant literature from January 2013 to October 2016. The present narrative review describes how sugammadex could play a crucial role in the modern conduct of anesthesia. The particular emphasis on sugammadex cost-effective analysis performed in this article suggests that this new reversal agent should be considered for a wider use in North America.

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Deep neuromuscular block improves surgical conditions during laparoscopic hysterectomy

Abstract: Inducing deep neuromuscular block (train-of-four count <1) significantly improved surgical field scores and made it possible to completely prevent unacceptable surgical conditions.

Cited by 109 publications

References 25 publications

Current Trends in Neuromuscular Blockade, Management, and Monitoring amongst Singaporean Anaesthetists

Current Trends in Neuromuscular Blockade, Management, and Monitoring amongst Singaporean Anaesthetists

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

A Short Update on Sugammadex with a Special Focus on Economic Assessment of its Use in North America

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