Yoo Young-Chul, Kim Na Young, Shin Seokyung, Choi Young Deuk, Hong Jung Hwa, Kim Chan Yun, Park HeeJoon, Bai Sun-Joon
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2015 Aug 28;10(8):e0135412. doi: 10.1371/journal.pone.0135412. eCollection 2015.
This study aimed to determine whether continuous deep neuromuscular blockade (NMB) improves the surgical conditions and facilitates robotic-assisted laparoscopic radical prostatectomy (RALRP) under low intra-abdominal pressure (IAP) to attenuate the increase in intraocular pressure (IOP) during CO2 pneumoperitoneum in the steep Trendelenburg (ST) position.
Sixty-seven patients undergoing RALRP were randomly assigned to a moderate NMB group (Group M), including patients who received atracurium infusion until the end of the ST position, maintaining a train of four count of 1-2; and the deep NMB group (Group D), including patients who received rocuronium infusion, maintaining a post-tetanic count of 1-2. IOP was measured in all patients at nine separate time points. All RALRPs were performed by one surgeon, who rated the overall and worst surgical conditions at the end of the ST position.
The highest IOP value was observed at T4 (60 min after the ST position) in both Group M (23.3 ± 2.7 mmHg) and Group D (19.8 ± 2.1 mmHg). RALRP was accomplished at an IAP of 8 mmHg in 88% Group D patients and 25% Group M patients. The overall surgical condition grade was 4.0 (3.0-5.0) in Group D and 3.0 (2.0-5.0) in Group M (P < 0.001).
The current study demonstrated that continuous deep NMB may improve surgical conditions and facilitate RALRP at a low IAP, resulting in significant attenuation of the increase on IOP. Moreover, low-pressure pneumoperitoneum, facilitated by deep NMB still provided acceptable surgical conditions.
ClinicalTrials.gov NCT02109133.
本研究旨在确定持续深度神经肌肉阻滞（NMB）是否能改善手术条件，并有助于在低腹内压（IAP）下进行机器人辅助腹腔镜根治性前列腺切除术（RALRP），以减轻在陡峭头低脚高位（ST）时二氧化碳气腹期间眼内压（IOP）的升高。
67例行RALRP的患者被随机分为中度NMB组（M组），包括接受阿曲库铵输注直至ST位结束，维持四个成串刺激计数为1-2的患者；以及深度NMB组（D组），包括接受罗库溴铵输注，维持强直后计数为1-2的患者。在九个不同时间点对所有患者测量IOP。所有RALRP均由一名外科医生进行，该医生在ST位结束时对总体和最差手术条件进行评分。
M组（23.3±2.7 mmHg）和D组（19.8±2.1 mmHg）在T4（ST位后60分钟）时观察到最高IOP值。88%的D组患者和25%的M组患者在8 mmHg的IAP下完成了RALRP。D组的总体手术条件评分为4.0（3.0-5.0），M组为3.0（2.0-5.0）（P<0.001）。
本研究表明，持续深度NMB可能改善手术条件，并有助于在低IAP下进行RALRP，从而显著减轻IOP的升高。此外，深度NMB辅助的低压气腹仍能提供可接受的手术条件。
ClinicalTrials.gov NCT02109133。
