Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair

Söderström, Carl Martin; Medici, Roar; Assadzadeh, Sami; Følsgaard, Søren; Rosenberg, Jacob; Gätke, Mona Ring; Madsen, Mia

doi:10.1097/eja.0000000000000833

Cited by 16 publications

(12 citation statements)

References 31 publications

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“…Further, deep NMB with lower intra-abdominal pressure were reported to provide few cardiopulmonary benefits during laparoscopic colorectal surgery [ 90 ]. Moreover, deep NMB did not improve the surgical view during laparoscopic ventral hernia repair and showed benefits only during suturing of the hernial defect [ 91 ]. However, studies on post-surgical outcomes are recent.…”

Section: Recent Clinical Interests Regarding Sugammadexmentioning

confidence: 99%

Advantages and pitfalls of clinical application of sugammadex

Lee

Jung

2020

Anesth Pain Med

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Sugammadex, a modified γ-cyclodextrin, is one of the drugs focused on in the anesthetic field because it provides rapid and complete reversal from neuromuscular blockade (NMB) by encapsulating rocuronium. Its introduction has revolutionized anesthesia practice because it is a safe, predictable, and reliable neuromuscular antagonist. Hence, its use has increased worldwide. Further, it has been in the spotlight for recovering from deep NMB in laparoscopic surgery and improving the surgical condition. Recently, studies have been conducted on the postoperative outcome after deep NMB and use of sugammadex in various clinical conditions. However, with increase in sugammadex use, reports regarding its complications are increasing. Appropriate dosing of sugammadex with quantitative neuromuscular monitoring is emphasized because under-dosing or over-dosing of sugammadex might be associated with unexperienced complications. Sugammadex is now leaping into an ideal reversal agent, changing the anesthesia practice.

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Section: Recent Clinical Interests Regarding Sugammadexmentioning

confidence: 99%

Advantages and pitfalls of clinical application of sugammadex

Lee

Jung

2020

Anesth Pain Med

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“…1 , PRISMA study selection flow chart), 22 papers were included in the review ( Table 4 ). We identified 12 that used propofol as primary anaesthetic agent, 6 , 10 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 of which six found a benefit of deep neuromuscular block on surgical working conditions, 6 , 10 , 19 , 25 , 26 , 27 and six did not. 28 , 29 , 30 , 31 , 32 , 33 In addition, 10 studies were identified that used an inhalation agent.…”

Section: Resultsmentioning

confidence: 99%

“…We identified 12 that used propofol as primary anaesthetic agent, 6 , 10 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 of which six found a benefit of deep neuromuscular block on surgical working conditions, 6 , 10 , 19 , 25 , 26 , 27 and six did not. 28 , 29 , 30 , 31 , 32 , 33 In addition, 10 studies were identified that used an inhalation agent. 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 Seven out of these 10 studies reported a benefit of deep neuromuscular block during inhalation anaesthesia on surgical working conditions.…”

Section: Resultsmentioning

confidence: 99%

“…Our systematic review identified 12 studies that used propofol as a primary anaesthetic, of which half found a benefit of deep neuromuscular block, 6 , 10 , 19 , 25 , 26 , 27 whereas the other half did not ( Table 4 ). 28 , 29 , 30 , 31 , 32 , 33 Significant methodological differences and the large heterogeneity in surgical procedures prevents drawing definitive conclusions from these studies. However, the results of our current (sevoflurane) and previous (propofol) studies 6 , 7 give an indication of the differential effects of propofol and sevoflurane on surgical working conditions in laparoscopic renal surgery.…”

Section: Discussionmentioning

confidence: 99%

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Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery

Honing

Martini

Olofsen

et al. 2021

British Journal of Anaesthesia

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Background Deep neuromuscular block is associated with improved working conditions during laparoscopic surgery when propofol is used as a general anaesthetic. However, whether deep neuromuscular block yields similar beneficial effects when anaesthesia is maintained using volatile inhalation anaesthesia has not been systematically investigated. Volatile anaesthetics, as opposed to intravenous agents, potentiate muscle relaxation, which potentially reduces the need for deep neuromuscular block to obtain optimal surgical conditions. We examined whether deep neuromuscular block improves surgical conditions over moderate neuromuscular block during sevoflurane anaesthesia. Methods In this single-centre, prospective, randomised, double-blind study, 98 patients scheduled for elective renal surgery were randomised to receive deep (post-tetanic count 1–2 twitches) or a moderate neuromuscular block (train-of-four 1–2 twitches). Anaesthesia was maintained with sevoflurane and titrated to bispectral index values between 40 and 50. Pneumoperitoneum pressure was maintained at 12 mm Hg. The primary outcome was the difference in surgical conditions, scored at 15 min intervals by one of eight blinded surgeons using a 5-point Leiden-Surgical Rating Scale (L-SRS) that scores the quality of the surgical field from extremely poor 1 to optimal 5 . Results Deep neuromuscular block did not improve surgical conditions compared with moderate neuromuscular block: mean (standard deviation) L-SRS 4.8 (0.3) vs 4.8 (0.4), respectively ( P =0.94). Secondary outcomes, including unplanned postoperative readmissions and prolonged hospital admission, were not significantly different. Conclusions During sevoflurane anaesthesia, deep neuromuscular block did not improve surgical conditions over moderate neuromuscular block in normal-pressure laparoscopic renal surgery. Clinical trial registration NL7844 ( www.trialregister.nl ).

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“…Nevertheless, it is in line with the ongoing controversial debate on neuromuscular blockade to improve surgical conditions. Whereas many publications present significantly better operating conditions during deep NMB, compared to a light block [3,4,8,14,[17][18][19], several other authors found no differences [1,15,20]. Park et al describe inconsistent results and state that "further studies are required to address the heterogeneity and power shortage demonstrated by the trial sequential analysis", in a previously published review [21].…”

Section: Discussionmentioning

confidence: 99%

Depth of Neuromuscular Block Is Not Associated with Abdominal Wall Distention or Surgical Conditions during Gynecologic Laparoscopic Operations. A Prospective Trial

Soltész

Mathes

Anapolski

et al. 2020

JCM

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The influence of the degree of a neuromuscular block (NMB) on surgical operating conditions during laparoscopic surgery is debated controversially. The extent of abdominal distension during the time course of the NMB was assessed as a new measurement tool. In 60 patients scheduled for gynecologic laparoscopic surgery, the increase of the abdominal wall length induced by the capnoperitoneum was measured at 5 degrees of the NMB: intense NMB—post-tetanic count (PTC) = 0; deep NMB—train-of-four count (TOF) = 0 and PTC = 1–5; medium NMB—PTC > 5 and TOF = 0–1; shallow NMB—TOF > 1; full recovery—train-of-four ratio TOFR > 90%. Simultaneously, the quality of operating conditions was assessed with a standardized rating scale (SRS) reaching from 1 (extremely poor conditions) to 5 (excellent conditions). Fifty patients could be included in the analysis. The abdominal wall length increased by 10–13 mm induced by the capnoperitoneum. SRS was higher during intense NMB (4.7 ± 0.5) vs. full recovery (4.5 ± 0.5) (mean ± SD; p = 0.025). Generally, an intense NMB did not increase abdominal wall length induced by capnoperitoneum. Additionally, its influence on the quality of surgical operating conditions seems to be of minor clinical relevance.

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Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair

Abstract: ClinicalTrials.gov, NCT02247466.

Cited by 16 publications

References 31 publications

Advantages and pitfalls of clinical application of sugammadex

Advantages and pitfalls of clinical application of sugammadex

Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery

Depth of Neuromuscular Block Is Not Associated with Abdominal Wall Distention or Surgical Conditions during Gynecologic Laparoscopic Operations. A Prospective Trial

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