The Effects of Neuromuscular Blockade on Operating Conditions During General Anesthesia for Spinal Surgery

Abstract

General anesthesia without muscle relaxant provides similar working conditions to those observed with muscle relaxant, and it is associated with earlier eye opening and extubation and higher level of consciousness on emergence from spinal surgery.

Comparison of Operating Conditions, Postoperative Pain and Recovery, and Overall Satisfaction of Surgeons with Deep vs. No Neuromuscular Blockade for Spinal Surgery under General Anesthesia: A Prospective Randomized Controlled Trial

“…Moreover, to our knowledge, there is just one report that explores the effectiveness of deep NMB in spinal surgery. Li et al [16] suggested that total intravenous anesthesia without a muscle relaxant provided similar operating conditions to those observed with a muscle relaxant in spine surgery with regard to muscle tone, airway pressure and body movements, which implies that NMB may be unnecessary in spinal surgery. However, in their study, the group with muscle relaxants did not receive standardized deep NMB.…”

“…On the contrary, few reports describe the impact of muscle relaxation in non-laparoscopic surgery [4,16,23,24,25,26,27]. Moreover, to our knowledge, there is just one report that explores the effectiveness of deep NMB in spinal surgery.…”

“…Outcomes measured included: (1) the mean value of peak inspiratory airway pressure (primary endpoint) and plateau airway pressure measured every 15 min during surgery; (2) the muscle tone scaled by surgeons (1–3: 1 = good, suitable for surgery; 2 = moderate, but did not affect the operation; and 3 = hard, making the operation difficult) [16] during placement of the back muscle retractor, screw insertion through the pedicle of spine, and the overall period; (3) the mean value of the back muscle retractor pressure every 15 minutes; (4) the number of body movements per patient; (5) the degree of bleeding in the surgical field on microscopic view by the surgeons (no bleeding (0) to severe bleeding (5)) [17]; (6) overall satisfaction scaled by the surgeons (1–10; no satisfaction (1) to absolute satisfaction (10)); (7) cumulative dose of rocuronium (induction, rescue, and total) and average infusion rate of anesthetics; and (8) TOF count/ratio and BIS scores, mean arterial pressure and heart rate at the main time points (baseline, after intubation, skin incision, 30, 60 and 120 min after skin incision and the end of surgery).…”

Effect of intraoperative neuromuscular blockade on postoperative sore throat and hoarseness in patients undergoing spinal surgery: a prospective observational study

“…A few studies have investigated the effect of NMB on intraoperative and postoperative outcomes during spinal surgery 2,3 . They mainly evaluated surgical conditions and recovery profiles according to the depth of NMB, but did not address postoperative sore throat and hoarseness.…”

“…Neuromuscular blocking agents are routinely used to facilitate tracheal intubation during induction of anesthesia and are commonly used to improve surgical conditions during the maintenance of general anesthesia. However, there have also been several concerns about their effectiveness in improving surgical conditions and side effects, including delayed recovery, residual paralysis, and hypersensitivity reactions [1][2][3][4] .…”