Incidence of insufficient intraoperative neuromuscular paralysis. A retrospective registry analysis

Hesler, Brian D.; Turan, Alparslan; Egan, Cameron; Yang, Dongsheng; Mascha, Edward J.; Devine, Scott; Kurz, Andrea; Sessler, Daniel I.; Saager, Leif

doi:10.1016/j.jclinane.2019.01.023

Cited by 3 publications

(5 citation statements)

References 32 publications

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“…During laparoscopic surgery, unsatisfactory visual field conditions often occur 17 . Neuromuscular blockers are essential to reduce the occurrence of unacceptable surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

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Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Wu,

Wei,

Xiang

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Neuromuscular block (NMB) is routinely used in paediatric and adult anaesthesia to facilitate endotracheal intubation and optimise surgical conditions. However, there are limited data regarding NMB and optimising the conditions for laparoscopic surgery in neonates and small infants. OBJECTIVE The goal of this study was to determine the effect of NMB on the conditions for laparoscopic surgery in neonates and small infants. DESIGN A randomised controlled trial. SETTING Single-centre Children's Hospital, conducted from November 2021 to December 2022. PATIENTS One hundred and two ASA I–II neonates and small infants aged up to 60 weeks postmenstrual age who were scheduled to undergo an elective laparoscopic Ladd's procedure were included in the study. INTERVENTIONS Patients were randomised into three groups: no NMB group, shallow NMB group and moderate NMB group. Each group was given different doses of rocuronium to achieve the target depth of NMB. MAIN OUTCOME MEASURES The primary outcome was the quality of the surgical conditions evaluated with the Leiden-Surgical Rating Scale (L-SRS) by a blinded surgeon. Secondary outcomes included tracheal intubating conditions and adverse events. RESULTS The percentage of L-SRS scores of 4 or 5 was similar among the three groups at all the assessment times (P > 0.05 for each time interval). The distribution of L-SRS scores was also similar among the three groups. There were no significant differences in operating condition scores between the groups at any time interval (P > 0.05 for each time interval). The incidence of adverse events during anaesthesia induction was significantly higher in the no NMB group (51.4%) than in the other two groups (13.6% and 14.7%) (adjusted P = 0.012 and adjusted P = 0.003). In particular, clinically unacceptable intubation conditions occurred in 12 patients (34.3%) in the no NMB group, significantly more than in the shallow NMB group (6.1%, adjusted P = 0.012) and moderate NMB group (2.9%, adjusted P = 0.003). There was no statistically significant difference in the incidence of adverse events in the PACU among the three groups (P = 0.103). CONCLUSIONS The depth of NMB was not associated with superior surgical conditions during laparoscopic surgery, but it was associated with a reduction in adverse events during induction and maintenance of anaesthesia in neonates and small infants. TRIAL REGISTRATION Registered at www.chictr.org.cn (ChiCTR2100052296).

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“…During laparoscopic surgery, unsatisfactory visual field conditions often occur 17 . Neuromuscular blockers are essential to reduce the occurrence of unacceptable surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…During laparoscopic surgery, unsatisfactory visual field conditions often occur. 17 Neuromuscular blockers are essential to reduce the occurrence of unacceptable surgical conditions. Strategies to reduce the incidence of unsatisfactory surgical conditions may reduce surgical complications and improve patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Wu,

Wei,

Xiang

et al. 2023

European Journal of Anaesthesiology

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“…Suboptimal surgical working conditions during procedures under general anaesthesia are commonly encountered. 34 These events are often benign and self-limiting but may potentially induce harm, especially when they occur unexpectedly at critical moments. Therefore, strategies that reduce these incidences may improve patient outcome.…”

Section: Discussionmentioning

confidence: 99%

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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“…For different surgical disciplines, insufficient muscle relaxation was observed in more than a quarter of patients and associated with poor intra-operative conditions. [1][2][3] In anaesthesia, neuromuscular blocking agents (NMBAs) are used not only to facilitate tracheal intubation but also to improve Eur J Anaesthesiol 2020; 37:1-8 EJA-D-20-00739 surgical conditions. 4,5 Moreover, for spinal surgery, deep neuromuscular blockade (NMB) has been shown to reduce intra-operative surgical bleeding due to greater relaxation in the paraspinal musculature and lower intraoperative peak inspiratory pressure.…”

Section: Introductionmentioning

confidence: 99%

“…Intra-operative muscle relaxation is of pivotal importance for visualisation of deep structures during a surgical exposure in orthopaedic surgery. For different surgical disciplines, insufficient muscle relaxation was observed in more than a quarter of patients and associated with poor intra-operative conditions 1–3 . In anaesthesia, neuromuscular blocking agents (NMBAs) are used not only to facilitate tracheal intubation but also to improve surgical conditions 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Hand or foot train-of-four tests and surgical site muscle relaxation assessed with multiple motor evoked potentials

Betz¹,

Aguirre²,

Schubert³

et al. 2020

European Journal of Anaesthesiology

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BACKGROUND Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity. OBJECTIVE The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials. DESIGN Prospective observational study. SETTING A single-centre study performed between February 2016

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Incidence of insufficient intraoperative neuromuscular paralysis. A retrospective registry analysis

Cited by 3 publications

References 32 publications

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

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

Hand or foot train-of-four tests and surgical site muscle relaxation assessed with multiple motor evoked potentials

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