Hospital Arnau de Vilanova de Valencia, C/ San Clement 12, 46015 Valencia, Spain.
Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014 Valencia, Spain.
J Clin Anesth. 2017 Nov;42:26-30. doi: 10.1016/j.jclinane.2017.08.005. Epub 2017 Aug 30.
To evaluate the influence of neuromuscular blockade (NMB) on surgical conditions during low-pressure pneumoperitoneum (8mmHg) laparoscopic cholecystectomy (LC), while comparing moderate and deep NMB. Secondary objective was to evaluate if surgical conditions during low-pressure pneumoperitoneum LC performed with deep NMB could be comparable to those provided during standard-pressure pneumoperitoneum (12mmHg) LC.
Prospective, randomized, blinded clinical trial.
Operating room.
Ninety ASA 1-2 patients scheduled for elective LC.
Patients were allocated into 3 groups: Group 1: low-pressure pneumoperitoneum with moderate-NMB (1-3 TOF), Group 2: low-pressure pneumoperitoneum with deep-NMB (1-5 PTC) and Group 3: standard pneumoperitoneum (12mmHg). Rocuronium was used to induce NMB and acceleromiography was used for NMB monitoring (TOF-Watch-SX).
Three experienced surgeons evaluated surgical conditions using a four-step scale at three time-points: surgical field exposure, dissection of the gallbladder and extraction/closure.
Low-pressure pneumoperitoneum (Group 1 vs. 2): good conditions: 96.7 vs. 96.7%, 90 vs. 80% and 89.6 vs. 92.3%, respectively for the time-points, p>0.05. No differences in optimal surgical conditions were observed between the groups. Surgery completion at 8mmHg pneumoperitoneum: 96.7 vs. 86.7%, p=0.353. Standard-pressure pneumoperitoneum vs. low-pressure pneumoperitoneum with deep NMB (Group 3 vs. 2): good conditions: 100% in Group 3 for the three time-points (p=0.024 vs. Group 2 at dissection of the gallbladder). Significantly greater percentage of optimal conditions during standard-pressure pneumoperitoneum LC at the three time points of evaluation.
The depth of NMB was found not to be decisive neither in the improvement of surgical conditions nor in the completion of low-pressure pneumoperitoneum LC performed by experienced surgeons. Surgical conditions were considered better with a standard-pressure pneumoperitoneum, regardless of the depth of NMB, than during low-pressure pneumoperitoneum with deep NMB.
评估在低压气腹（8mmHg）腹腔镜胆囊切除术（LC）期间神经肌肉阻滞（NMB）对手术条件的影响，同时比较中度和深度 NMB。次要目标是评估在深度 NMB 下进行低压气腹 LC 时的手术条件是否可与标准压力气腹（12mmHg）LC 提供的条件相媲美。
前瞻性、随机、盲法临床试验。
手术室。
90 名 ASA 1-2 级择期行 LC 的患者。
患者被分为 3 组：组 1：低压气腹+中度 NMB（1-3 TOF），组 2：低压气腹+深度 NMB（1-5 PTC），组 3：标准气压气腹（12mmHg）。使用罗库溴铵诱导 NMB，并使用加速肌电图监测 NMB（TOF-Watch-SX）。
3 名经验丰富的外科医生在三个时间点使用四步评分法评估手术条件：手术野暴露、胆囊解剖和提取/关闭。
低压气腹（组 1 与组 2）：良好条件：在时间点上分别为 96.7%、90%和 89.6%，p>0.05。两组之间未观察到最佳手术条件的差异。在 8mmHg 气腹下完成手术：96.7%与 86.7%，p=0.353。标准气压气腹与深度 NMB 下的低压气腹（组 3 与组 2）：良好条件：组 3 在三个时间点均为 100%（p=0.024 与组 2 在胆囊解剖时相比）。在三个评估时间点，标准压力气腹 LC 时更优条件的百分比显著更高。
NMB 的深度既不能改善手术条件，也不能决定经验丰富的外科医生进行的低压气腹 LC 的完成。与深度 NMB 下的低压气腹相比，标准压力气腹无论 NMB 深度如何，手术条件均被认为更好。
