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Comparison of Deep and Moderate Neuromuscular Blockade for Major Laparoscopic Surgery in Children: A Randomized Controlled Trial

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Abstract

Background and Objective

Neuromuscular blocking agents are routinely used in laparoscopic surgery to optimize operative conditions. We compared the effect of a deep and moderate neuromuscular blockade (NMB) on surgical conditions and postoperative outcomes in children undergoing major laparoscopic surgery.

Methods

Sixty children aged 2–14 years scheduled to undergo major laparoscopic surgery were randomly allocated to deep (post-tetanic count 1–2 twitches) or moderate (train-of-four 1–2 twitches) NMB groups. The anesthesia was maintained with propofol and remifentanil, and the NMB was maintained with a rocuronium continuous infusion. At the end of the operation, the NMB were antagonized with sugammadex. The intra-abdominal pressure, airway pressure, Leiden Surgical Rating Scale, intraoperative hemodynamics, drug usages, duration of surgery, postoperative recovery time, pain, and complications were compared between the groups.

Results

The maximum and mean intra-abdominal pressure, the peak inspiratory pressure, and mean airway pressure were significantly lower in the deep NMB group than in the moderate NMB group (p < 0.001). The Leiden Surgical Rating Scale and the dosage of rocuronium were significantly higher in the deep NMB group than the moderate NMB group (p < 0.001). The intraoperative hemodynamics, duration of surgery, post-operative recovery time, pain, and the incidence rate of complications were not significantly different between the groups (p > 0.05).

Conclusions

A deep NMB provided better operative conditions and similar recovery profiles compared with a moderate NMB as reversed with sugammadex in children undergoing major laparoscopic surgery.

Clinical Trial Registration

Chinese Clinical Trial Registry, No. ChiCTR2100053821.

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Author notes

  1. John Wei Zhong and Shou-Dong Pan have contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, 100020, China

    Guo Wei, Yong-Xin Li, Ying Chen & Shou-Dong Pan

  2. Department of General and Neonate Surgery, Capital Institute of Pediatrics, Beijing, China

    Mei Diao

  3. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center and Children’s Health of Texas, Dallas, 75390, TX, USA

    John Wei Zhong

Authors
  1. Guo Wei
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  4. Mei Diao
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Corresponding authors

Correspondence to John Wei Zhong or Shou-Dong Pan.

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Funding

This research was funded by The Wu Jie-Ping Medical Foundation (project number: 320.6750.2021-05-4).

Conflict of interest

Guo Wei, Yong-Xin Li, Ying Chen, Mei Diao, John Wei Zhong, and Shou-Dong Pan have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

The protocol was approved by the Research Ethics Committee of Capital Institute of Pediatrics, Beijing, China (No. SHERLL2020060). The study was conducted in accordance with all applicable laws, rules, and regulations and with the Declaration of Helsinki and the International Council for Harmonisation guidelines for Good Clinical Practice.

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Author contributions

GW: literature review; data curation; methodology; analysis and interpretation of the data; writing - original draft. Y-XL and MD: data curation; analysis and interpretation of the data. YC: literature review; analysis and interpretation of the data. JWZ and S-DP: design of the study; final approval of the version to be published. All authors read and approved the final version of the manuscript.

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Wei, G., Li, YX., Chen, Y. et al. Comparison of Deep and Moderate Neuromuscular Blockade for Major Laparoscopic Surgery in Children: A Randomized Controlled Trial. Pediatr Drugs (2024). https://doi.org/10.1007/s40272-024-00622-0

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  • DOI: https://doi.org/10.1007/s40272-024-00622-0

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