Department of Anesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.
Department of Anesthesiology, Aarhus University Hospital, Nørrebrogade, Denmark.
Br J Anaesth. 2017 Sep 1;119(3):435-442. doi: 10.1093/bja/aex241.
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.
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.
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.
Deep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy.
NCT02140593.
在剖腹手术中，如果患者的腹壁或横膈紧张，外科医生可能会遇到困难的手术情况。深度神经肌肉阻滞（NMB）定义为强直后计数（PTC）为 0-1，使腹壁肌肉和横膈麻痹。我们假设与标准 NMB 相比，深度 NMB（PTC 0-1）可改善上腹部剖腹手术期间的手术条件主观评分。
这是一项双盲、随机研究。共纳入 128 例择期行上腹部剖腹手术的患者，随机分为持续深度 NMB 组（罗库溴铵输注 2mg/ml）或标准 NMB 组（罗库溴铵 10mg 推注或增加麻醉深度）。每隔 30min 使用 5 分制主观评分量表（1：极差，5：最佳）评估手术条件。主要结局为患者手术条件评分的平均值。其他结局包括筋膜关闭时的手术评分、需要优化手术条件的发作次数、伤口裂开和感染的发生情况。
与标准 NMB 相比，深度 NMB 可改善手术条件评分；中位数分别为 4.75（范围 3-5）和 4.00（范围 1-5）（P<0.001）。与标准 NMB 相比，深度 NMB 可改善筋膜关闭时的手术条件评分（P<0.001）、减少需要优化手术条件的发作次数（P<0.001）和减少突然运动的发作次数（P<0.001）。两组手术时间、伤口感染和伤口裂开的发生率无差异。
与标准 NMB 相比，深度 NMB 可改善剖腹手术期间的手术条件主观评分。
NCT02140593。
