Requirements for Muscle Relaxants during Radical Retropubic Prostatectomy

King, Melinda A.; Sujirattanawimol, Nuntiya; Danielson, David R.; Hall, Brian A.; Schroeder, Darrell R.; Warner, David O.

doi:10.1097/00000542-200012000-00008

Cited by 78 publications

(46 citation statements)

References 18 publications

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“…Many surgeons strongly advocate complete intraoperative muscle paralysis with little evidence that this practice essentially improves surgical conditions. 28 % of patients undergoing radical retro-pubic prostatectomy without neuromuscular blockade had unacceptable surgical conditions compared to 2 % of the patients who had received vecuronium [18]. Compared to lower abdominal surgery, we expected a higher demand for muscle paralysis in upper abdominal and even more in laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 93%

“…We decided to perform this study, because thorough literature search revealed only two studies investigating this daily discussed question, in one the surgeons were not blinded [22], in the other study blinding was questioned by the authors themselves [18]. Accordingly, the study design was tailored in favour of the hypothesis by two extreme regimes of muscle paralysis for laparoscopic surgery which is known to be very sensitive for inadequate muscle relaxation.…”

Section: Discussionmentioning

confidence: 99%

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Neuromuscular blockade improves surgical conditions (NISCO)

et al. 2014

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Neuromuscular blockade improves surgical conditions (NISCO)

et al. 2014

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“…Even traditional thinking, such as the reasoning that good diaphragmatic relaxation lowers intra-abdominal pressure, and hence is necessary for abdominal surgery, has been questioned. Whereas one recent human study showed that neuromuscular blockade could improve operating conditions in abdominal surgery, 69 another study in laparoscopic surgery did not show any influence of diaphragmatic relaxation on intra-abdominal pressure or inspiratory pressure. 70 Due to the complex interaction of several factors creating good operating conditions, such as depth of anesthesia, surgical exposure and skills, and the degree of muscle relaxation at the operating site, the influence of the degree of diaphragmatic relaxation on certain operating conditions is hard to judge.…”

Section: Importance Of Neuromuscular Block At the Diaphragmmentioning

confidence: 90%

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Hemmerling

Donati

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To review recent findings concerning neuromuscular blockade and monitoring at the larynx, the diaphragm, and the corrugator supercilii muscle.S So ou ur rc ce e: : This narrative review is based on recent publications. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Neuromuscular blockade at the larynx and the diaphragm is less intense than at the adductor pollicis muscle; the onset and offset of neuromuscular blockade is more rapid. The corrugator supercilii muscle reflects better the time course of neuromuscular blockade of the larynx than the adductor pollicis muscle, is better suited to monitor the onset of neuromuscular blockade for intubation, and should give a better reflection of the time course and degree of neuromuscular blockade of the larynx or the diaphragm. Recovery of neuromuscular function at the end of any procedure is best reflected at the adductor pollicis muscle where neuromuscular transmission is last restored. Clinical monitoring of the larynx or the diaphragm is still limited by the absence of a simple method. Acceleromyography of the corrugator supercilii muscle is prone to artifacts that do not occur during monitoring of the adductor pollicis muscle. Phonomyography, a new method of monitoring that is currently being tested, is based on the phenomenon that muscle contraction creates low-frequency sound waves, which can be detected using special microphones to quantify neuromuscular blockade. This method seems promising because it can be easily used on all muscles of interest.C Co on nc cl lu us si io on n: : Research during the last 15 years has greatly enhanced our knowledge about how muscles react differently to muscle relaxants and has enabled us to achieve better surgical conditions with safer use of muscle relaxants. Interesting technologies have been developed to reliably monitor neuromuscular blockade at the larynx and the diaphragm, but are currently restricted to research settings. Our increased understanding should help us in ongoing efforts to develop the "ideal" muscle relaxant and the "ideal" method of neuromuscular monitoring. Objectif

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“…9 Although clinical judgment of surgical conditions (e.g., adequate relaxation) can be subjective, recent studies have shown that NMBDs can improve surgical conditions, most specifically in abdominal surgery. 10,11 Neuromuscular blockade can be used to maintain a lighter plane of anesthesia; profound NMB can be useful for procedures such as intracranial surgery or complex eye surgery where even slight movement could result in critical events.…”

Section: Rationale For Routine Monitoring Of Neuromuscular Functionmentioning

confidence: 99%

Brief review: Neuromuscular monitoring: an update for the clinician

Hemmerling

Lê

2007

Can J Anesth/J Can Anesth

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Purpose:To review established techniques and to provide an update on new methods for clinical monitoring of neuromuscular function relevant to anesthesia.Source: A PubMed search of relevant article for the period 1985-2005 was undertaken, and bibliographies were scanned for additional sources. Principal findings:There is no substitute for objective neuromuscular monitoring; for research purposes, mechanomyography (MMG) is the gold standard; however, the most versatile method in the clinical setting is acceleromyography since it can be applied at various muscles and has a long track record of clinical utility. Kinemyography is valid to monitor recovery of neuromuscular transmission at the adductor pollicis muscle (AP), whereas phonomyography is easy to apply to various muscles and shows promising agreement with MMG. Monitoring of the corrugator supercilii muscle (CS) may be used to determine the earliest time for tracheal intubation as it reflects laryngeal relaxation better than monitoring at the AP. Recovery of neuromuscular transmission is best monitored at the AP, since it is the last muscle to recover from neuromuscular blockade (NMB). If train-of-four (TOF) stimulation is used, a TOF-ratio > 0.9 should be the target before awakening the patient. If surgery or the type of anesthesia necessitates NMB of a certain degree, e.g., TOF-ratio = 0.25, monitoring of muscles which best reflect the degree of NMB at the surgical site is preferable. Conclusion:Objective methods should be used to monitor neuromuscular function in clinical anesthesia. Acceleromyography offers the best compromise with respect to ease of use, practicality, versatility, precision and applicability at various muscles.The CS is the optimal muscle to determine the earliest time for intubation, e.g., for rapid sequence induction.

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Requirements for Muscle Relaxants during Radical Retropubic Prostatectomy

Cited by 78 publications

References 18 publications

Neuromuscular blockade improves surgical conditions (NISCO)

Neuromuscular blockade improves surgical conditions (NISCO)

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Brief review: Neuromuscular monitoring: an update for the clinician

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