Vollrelaxation

Unterbuchner, Christoph; Blobner, Manfred

doi:10.1007/s00101-018-0425-6

Cited by 10 publications

(3 citation statements)

References 89 publications

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“…By this approach, we were able to evaluate all degrees of the NMB, from an intense block (PTC = 0) to full recovery, without inter-individual differences. Additionally, the definition of deep or light NMB varies slightly between different investigations, sometimes making it difficult to compare the results of different studies [14,15,23]. By measuring more than two different degrees, we avoided this problem.…”

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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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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“…30,32 Consequently, a more liberal use of NMB agents and their reversal agents became common practice. 36–38 When reversal agents in inappropriately low doses are given at deeper levels of block, the phenomenon of reoccurrence of NMB reemerged, 39,40 a problem formerly known as “recurarization.” 41 However, even after recommended doses of neostigmine and sugammadex in the absence of quantitative monitoring, reoccurrence of NMB was recently observed particularly in elderly 42 and in obese patients. 43,44…”

Section: Pro: Quantitative Neuromuscular Monitoring In the Era Of Sug...mentioning

confidence: 99%

Pro-Con Debate: Do We Need Quantitative Neuromuscular Monitoring in the Era of Sugammadex?

Blobner

Hollmann

Luedi

et al. 2022

Anesthesia &Amp; Analgesia

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In this Pro-Con article, we debate the merits of using quantitative neuromuscular blockade monitoring. Consensus guidelines recommend their use to guide the administration of nondepolarizing neuromuscular blockade and reversal agents. A major impediment to this guideline is that until recently, reliable quantitative neuromuscular blockade monitors have not been widely available. Without them, anesthesia providers have been trained with and are adept at using a variety of qualitative neuromuscular blockade monitors otherwise known as peripheral nerve stimulators. Although perhaps less accurate, anesthesia providers find them reliable and easy to use. They have a long track record of using them with the perception that their use leads to effective neuromuscular blockade reversal and minimizes clinically significant adverse events from residual neuromuscular blockade. In the recent past, 2 disruptive developments have called upon anesthesia care providers to reconsider their practice in neuromuscular blockade administration, reversal, and monitoring. These include: (1) commercialization of more reliable quantitative neuromuscular monitors and (2) widespread use of sugammadex, a versatile reversal agent of neuromuscular blockade. Sugammadex appears to be so effective at rapidly and effectively reversing even the deepest of neuromuscular blockades, and it has left anesthesia providers wondering whether quantitative monitoring is indeed necessary or whether conventional, familiar, and less expensive qualitative monitoring will suffice? This Pro-Con debate will contrast anesthesia provider perceptions with evidence surrounding the use of quantitative neuromuscular blockade monitors to explore whether quantitative neuromuscular monitoring (NMM) is just another technology solution looking for a problem or a significant advance in NMM that will improve patient safety and outcomes.

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“…. Unverändert empfehlen daher die Autoren dieses Kommen-tars ein Konzept der situativen Vertiefung der Relaxation im Sinne einer "goal-directed relaxation" [7].…”

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Tiefe Relaxierung kann laparoskopische Eingriffe erleichtern

2018

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Vollrelaxation

Cited by 10 publications

References 89 publications

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

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

Pro-Con Debate: Do We Need Quantitative Neuromuscular Monitoring in the Era of Sugammadex?

Tiefe Relaxierung kann laparoskopische Eingriffe erleichtern

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