Dubois Philippe E, Putz Laurie, Jamart Jacques, Marotta Maria-Laura, Gourdin Maximilien, Donnez Olivier
From the Department of Anaesthesiology (PED, LP, MG), Department of Gynaecology (M-LM, OD), and Scientific Support Unit (JJ), University of Louvain, CHU Dinant Godinne, Yvoir, Belgium.
Eur J Anaesthesiol. 2014 Aug;31(8):430-6. doi: 10.1097/EJA.0000000000000094.
The benefit of inducing deep neuromuscular block to improve laparoscopic surgical conditions is controversial.
The goal of this study was to determine the depth of neuromuscular block needed to guarantee excellent operating conditions during laparoscopic hysterectomy.
A randomised controlled trial.
A single-centre study performed between February 2011 and May 2012.
One hundred and two women of ASA physical status 1 or 2 gave consent to participate and were allocated randomly to one of two groups.
Under desflurane general anaesthesia, patients in Group S (shallow block), neuromuscular blockade was induced by administration of rocuronium 0.45 mg kg-1 followed by spontaneous recovery or a rescue bolus dose of 5 mg if surgical conditions were unacceptable. In Group D (deep block), neuromuscular block was induced by administration of rocuronium 0.6 mg kg-1 and maintained by bolus doses of 5 mg if the train-of-four count exceeded two, using adductor pollicis electromyography.
With a stable pneumoperitoneum (13 mmHg), the surgeon scored the quality of the surgical field every 10 min as excellent (1), good but not optimal (2), poor but acceptable (3) or unacceptable (4). The groups were compared using the Cochran-Armitage trend test. The level of neuromuscular blockade was recorded each time the surgical field score exceeded 1.
For groups S and D, respectively, the maximum surgical field scores were 1 in 21 and 34 patients, 2 in 11 and 11 patients, 3 in 4 and 5 patients and 4 in 14 and 0 patients. A trend towards higher scores was demonstrated in group S (P < 0.001). Surgical field scores of 2, 3 and 4 occurred only when the train-of-four count was at least 1, 2 and 3, respectively.
Inducing deep neuromuscular block (train-of-four count <1) significantly improved surgical field scores and made it possible to completely prevent unacceptable surgical conditions.
诱导深度神经肌肉阻滞以改善腹腔镜手术条件的益处存在争议。
本研究的目的是确定在腹腔镜子宫切除术中保证良好手术条件所需的神经肌肉阻滞深度。
一项随机对照试验。
2011年2月至2012年5月进行的单中心研究。
102名美国麻醉医师协会（ASA）身体状况为1或2级的女性同意参与研究，并被随机分配到两组中的一组。
在地氟醚全身麻醉下，S组（浅阻滞）患者通过静脉注射罗库溴铵0.45mg/kg诱导神经肌肉阻滞，随后自然恢复，若手术条件不理想则给予5mg的追加剂量。D组（深阻滞）患者通过静脉注射罗库溴铵0.6mg/kg诱导神经肌肉阻滞，并使用拇收肌肌电图，当四个成串刺激计数超过2时给予5mg的追加剂量以维持阻滞。
在稳定气腹（13mmHg）下，外科医生每10分钟对手术视野质量进行评分，分为优（1分）、良但非最佳（2分）、差但可接受（3分）或不可接受（4分）。使用 Cochr an-Armitage趋势检验对两组进行比较。每次手术视野评分超过1分时记录神经肌肉阻滞水平。
S组和D组中，手术视野最高评分为1分的患者分别有21例和34例，评分为2分的分别有11例和11例，评分为3分的分别有4例和5例，评分为4分的分别有14例和0例。S组呈现出评分更高的趋势（P<0.001）。手术视野评分为2分、3分和4分仅分别出现在四个成串刺激计数至少为1、2和3时。
诱导深度神经肌肉阻滞（四个成串刺激计数<1）可显著提高手术视野评分，并完全防止出现不可接受的手术条件。
