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Randomized Clinical Trial of Moderate Versus Deep Neuromuscular Block for Low-Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy

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Abstract

Background

The beneficial effects of deep blockade are not fully known. In this study, we evaluated the effect of deep neuromuscular blockade on surgical conditions during laparoscopic cholecystectomy under low-pressure pneumoperitoneum.

Methods

Patients undergoing elective laparoscopic cholecystectomy were randomized to either the moderate group (train-of-four count of 1 or 2) or deep group (posttetanic count of 1 or 2). Neuromuscular blockade was induced and maintained with rocuronium; it was reversed with sugammadex in the deep group and with neostigmine in the moderate group. At the beginning of surgery, the intra-abdominal pressure was set at 8 mmHg. The surgeon rated the surgical condition on a 4-point scale (1 = excellent, 2 = good, 3 = acceptable, 4 = poor) and was allowed to increase the pressure to 12 mmHg if it was determined that the surgical conditions were inadequate for the operation.

Results

A total of 64 patients completed the study. The rate of increasing intra-abdominal pressure to maintain optimal surgical conditions was 34.4 % in the moderate group and 12.5 % in the deep group (P = 0.039). The proportion of patients with a surgical condition score of 1 or 2 (excellent or good) was 34.4 % in the moderate group and 68.8 % in the deep group (P = 0.006).

Conclusion

The maintenance of intraoperative deep neuromuscular blockade was associated with a lower rate of conversion to standard pressure and higher surgeon satisfaction with the surgical conditions than was moderate blockade in patients undergoing low-pressure pneumoperitoneum laparoscopic cholecystectomy.

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Acknowledgments

Supported by a Grant (02-2013-088) from the Seoul National University Bundang Hospital Research Fund.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-do, 13620, Republic of Korea

    Bon-Wook Koo, Ah-Young Oh & Ji-Won Han

  2. Department of Dental Anesthesiology, College of Dentistry Seoul National University, Yeongeon-dong, Jongno-gu, Seoul, 110-749, Republic of Korea

    Kwang-Suk Seo

  3. Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea

    Ho-Seong Han & Yoo-Seok Yoon

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  1. Bon-Wook Koo
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  2. Ah-Young Oh
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  3. Kwang-Suk Seo
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  4. Ji-Won Han
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  5. Ho-Seong Han
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Corresponding author

Correspondence to Ah-Young Oh.

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Additional information

Trial registration number: registered at cris.nih.go.kr (KCT0001090).

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Koo, BW., Oh, AY., Seo, KS. et al. Randomized Clinical Trial of Moderate Versus Deep Neuromuscular Block for Low-Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy. World J Surg 40, 2898–2903 (2016). https://doi.org/10.1007/s00268-016-3633-8

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  • DOI: https://doi.org/10.1007/s00268-016-3633-8

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