M V Madsen1, S Scheppan2, E Mørk1,2, P Kissmeyer3, J Rosenberg4, M R Gätke1. 1. Department of Anesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark. 2. Department of Anesthesiology, Aarhus University Hospital, Nørrebrogade, Denmark. 3. Department of Gastrointestinal Surgery, Aarhus University Hospital, Nørrebrogade, Denmark. 4. Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.
Abstract
BACKGROUND: During laparotomy, surgeons may experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. Deep neuromuscular block (NMB), defined as a post-tetanic-count (PTC) between 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesized that deep NMB (PTC 0-1) would improve subjective ratings of surgical conditions during upper laparotomy as compared with standard NMB. METHODS: This was a double blinded, randomized study. A total of 128 patients undergoing elective upper laparotomy were randomized to either continuous deep NMB (infusion of rocuronium 2 mg ml -1 ) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia). Surgical conditions were evaluated using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min. Primary outcome was the average of scores for a patient's surgical conditions. Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection. RESULTS: Deep compared with standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3-5) compared with 4.00 (range 1-5) ( P <0.001), respectively. Deep compared with standard NMB resulted in better ratings of surgical conditions during fascial closure ( P <0.001), fewer episodes of need to optimize surgical conditions ( P <0.001), and fewer incidents with sudden movements ( P <0.001). No differences in operating time, occurrence of wound infection, and wound dehiscence were found. CONCLUSIONS: Deep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy. CLINICAL TRIAL REGISTRATION: NCT02140593.
BACKGROUND: During laparotomy, surgeons may experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. Deep neuromuscular block (NMB), defined as a post-tetanic-count (PTC) between 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesized that deep NMB (PTC 0-1) would improve subjective ratings of surgical conditions during upper laparotomy as compared with standard NMB. METHODS: This was a double blinded, randomized study. A total of 128 patients undergoing elective upper laparotomy were randomized to either continuous deep NMB (infusion of rocuronium 2 mg ml -1 ) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia). Surgical conditions were evaluated using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min. Primary outcome was the average of scores for a patient's surgical conditions. Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection. RESULTS: Deep compared with standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3-5) compared with 4.00 (range 1-5) ( P <0.001), respectively. Deep compared with standard NMB resulted in better ratings of surgical conditions during fascial closure ( P <0.001), fewer episodes of need to optimize surgical conditions ( P <0.001), and fewer incidents with sudden movements ( P <0.001). No differences in operating time, occurrence of wound infection, and wound dehiscence were found. CONCLUSIONS: Deep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy. CLINICAL TRIAL REGISTRATION: NCT02140593.
Authors: Moira H D Bruintjes; Piet Krijtenburg; Chris H Martini; Paul P Poyck; Frank C H d'Ancona; Volkert A L Huurman; Michel van der Jagt; Johan F Langenhuijsen; Willemijn N Nijboer; Cornelis J H M van Laarhoven; Albert Dahan; Michiel C Warlé Journal: Eur J Anaesthesiol Date: 2019-07 Impact factor: 4.330
Authors: G H Maarten Honing; Christian H Martini; Erik Olofsen; Rob F M Bevers; Volkert A L Huurman; Ian P J Alwayn; Monique van Velzen; Marieke Niesters; Leon P H J Aarts; Albert Dahan; Martijn Boon Journal: Br J Anaesth Date: 2020-10-20 Impact factor: 9.166