Comparison between the effects of deep and moderate neuromuscular blockade during transurethral resection of bladder tumor on endoscopic surgical condition and recovery profile: a prospective, randomized, and controlled trial
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To compare between deep neuromuscular blockade (NMB) and moderate NMB with respect to endoscopic surgical conditions and recovery profiles in patients with general anesthesia for transurethral resection of bladder (TURB).
108 patients undergoing elective TURB were randomized into two groups: the moderate NMB (n = 54) or deep NMB (n = 54) group. After the operation, NMB was reversed with 2 mg/kg sugammadex at a train-of-four (TOF) count of 1 or 2 (moderate NMB group) or with 4 mg/kg sugammadex at post-tetanic count (PTC) of 2 (deep NMB group). Surgeons, who were blinded to the study design, rated the endoscopic surgical condition on a 5-point scale (1 = extremely poor, 2 = poor, 3 = acceptable, 4 = good, 5 = optimal) immediately following the operation. Recovery profiles, including postoperative residual curarization (PORC), respiratory complication, and recovery time, were recorded.
No difference was observed between the two groups regarding patients and anesthesia characteristics. There were statistically significant differences in endoscopic surgical conditions between the two groups (P < 0.001). Thirty-eight patients in the deep NMB group (74%) showed optimal surgical conditions, whereas 16 patients in the moderate NMB group (30%) showed optimal endoscopic surgical conditions. No PORC and respiratory complications occurred in both groups, and no difference was found between the two groups in terms of recovery profiles, including recovery time and other adverse events.
Deep NMB and reversal with sugammadex improved the endoscopic surgical condition without complications compared with moderate NMB and reversal with sugammadex in patients undergoing TURB.
KeywordsBladder cancer Endoscopic surgery Neuromuscular blockade Surgical space condition
American Society of Anesthesiologists physical status classification
Body mass index
Post-anesthetia care unit
This work was supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinion in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp.
CHK manuscript writing/editing. SHC data collection and management. BGK data collection and management. BHM protocol development and editing. SCL scoring endoscopic surgical condition. AYO Protocol development and revision. YTJ data collection and analysis. JHR protocol development and data analysis, manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
Dr. C. H. Koo, S. H. Chung, B. G. Kim, B. H. Min, S. C. Lee, A. Y. Oh, Y. T. Jeon and J. H. Ryu have no conflicts of interest or financial ties to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
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