Kim Myoung Hwa, Lee Ki Young, Lee Kang-Young, Min Byung-Soh, Yoo Young Chul
From the Department of Anesthesiology and Pain Medicine (MHK, KYL, YCY); Anesthesia and Pain Research Institute (MHK, KYL,YCY); and Division of Colon and Rectal Surgery, Department of Surgery (KYL, BSM), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea.
Medicine (Baltimore). 2016 Mar;95(9):e2920. doi: 10.1097/MD.0000000000002920.
Carbon dioxide (CO2) absorption and increased intra-abdominal pressure can adversely affect perioperative physiology and postoperative recovery. Deep muscle relaxation is known to improve the surgical conditions during laparoscopic surgery. We aimed to compare the effects of deep and moderate neuromuscular block in laparoscopic colorectal surgery, including intra-abdominal pressure. In this prospective, double-blind, parallel-group trial, 72 adult patients undergoing laparoscopic colorectal surgery were randomized using an online randomization generator to achieve either moderate (1-2 train-of-four response, n = 36) or deep (1-2 post-tetanic count, n = 36) neuromuscular block by receiving a continuous infusion of rocuronium. Adjusted intra-abdominal pressure, which was titrated by a surgeon with maintaining the operative field during pneumoperitoneum, was recorded at 5-minute intervals. Perioperative hemodynamic parameters and postoperative outcomes were assessed. Six patients from the deep and 5 from the moderate neuromuscular block group were excluded, leaving 61 for analysis. The average adjusted IAP was lower in the deep compared to the moderate neuromuscular block group (9.3 vs 12 mm Hg, P < 0.001). The postoperative pain scores (P < 0.001) and incidence of postoperative shoulder tip pain were lower, whereas gas passing time (P = 0.002) and sips of water time (P = 0.005) were shorter in the deep neuromuscular block than in the moderate neuromuscular block group. Deep neuromuscular blocking showed several benefits compared to conventional moderate neuromuscular block, including a greater intra-abdominal pressure lowering effect, whereas surgical conditions are maintained, less severe postoperative pain and faster bowel function recovery.
二氧化碳（CO₂）吸收及腹内压升高会对围手术期生理状况及术后恢复产生不利影响。已知深度肌肉松弛可改善腹腔镜手术期间的手术条件。我们旨在比较深度和中度神经肌肉阻滞在腹腔镜结直肠手术中的效果，包括对腹内压的影响。在这项前瞻性、双盲、平行组试验中，72例接受腹腔镜结直肠手术的成年患者使用在线随机发生器进行随机分组，通过持续输注罗库溴铵实现中度（四个成串刺激反应为1 - 2，n = 36）或深度（强直后计数为1 - 2，n = 36）神经肌肉阻滞。在气腹期间由外科医生调节以维持手术视野的调整后腹内压，每隔5分钟记录一次。评估围手术期血流动力学参数和术后结局。深度神经肌肉阻滞组6例患者和中度神经肌肉阻滞组5例患者被排除，剩余61例用于分析。与中度神经肌肉阻滞组相比，深度神经肌肉阻滞组的平均调整后腹内压更低（9.3 vs 12 mmHg，P < 0.001）。深度神经肌肉阻滞组的术后疼痛评分更低（P < 0.001），术后肩峰下疼痛发生率更低，而排气时间（P = 0.002）和饮水时间（P = 0.005）比中度神经肌肉阻滞组更短。与传统的中度神经肌肉阻滞相比，深度神经肌肉阻滞显示出多种益处，包括更大的降低腹内压效果，同时维持手术条件，术后疼痛较轻且肠道功能恢复更快。
