Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, South Korea.
World J Urol. 2019 Feb;37(2):359-365. doi: 10.1007/s00345-018-2398-0. Epub 2018 Jul 2.
To compare between deep neuromuscular blockade (NMB) and moderate NMB with respect to endoscopic surgical conditions and recovery profiles in patients with general anesthesia for transurethral resection of bladder (TURB).
108 patients undergoing elective TURB were randomized into two groups: the moderate NMB (n = 54) or deep NMB (n = 54) group. After the operation, NMB was reversed with 2 mg/kg sugammadex at a train-of-four (TOF) count of 1 or 2 (moderate NMB group) or with 4 mg/kg sugammadex at post-tetanic count (PTC) of 2 (deep NMB group). Surgeons, who were blinded to the study design, rated the endoscopic surgical condition on a 5-point scale (1 = extremely poor, 2 = poor, 3 = acceptable, 4 = good, 5 = optimal) immediately following the operation. Recovery profiles, including postoperative residual curarization (PORC), respiratory complication, and recovery time, were recorded.
No difference was observed between the two groups regarding patients and anesthesia characteristics. There were statistically significant differences in endoscopic surgical conditions between the two groups (P < 0.001). Thirty-eight patients in the deep NMB group (74%) showed optimal surgical conditions, whereas 16 patients in the moderate NMB group (30%) showed optimal endoscopic surgical conditions. No PORC and respiratory complications occurred in both groups, and no difference was found between the two groups in terms of recovery profiles, including recovery time and other adverse events.
Deep NMB and reversal with sugammadex improved the endoscopic surgical condition without complications compared with moderate NMB and reversal with sugammadex in patients undergoing TURB.
比较深度神经肌肉阻滞（NMB）与中度 NMB 对全麻下经尿道膀胱肿瘤切除术（TURB）患者内镜手术条件和恢复情况的影响。
将 108 例行择期 TURB 的患者随机分为两组：中度 NMB 组（n=54）或深度 NMB 组（n=54）。术后，TOF 计数为 1 或 2 时用 2mg/kg 琥珀酸司可林（中度 NMB 组）或 PTC 计数为 2 时用 4mg/kg 琥珀酸司可林（深度 NMB 组）逆转 NMB。术者在不知道研究设计的情况下，在术后即刻对内镜手术条件进行 5 分制评分（1=极差，2=差，3=可，4=好，5=优）。记录术后残余肌松（PORC）、呼吸并发症和恢复时间等恢复情况。
两组患者和麻醉特征无差异。两组内镜手术条件存在统计学差异（P<0.001）。深度 NMB 组 38 例（74%）患者手术条件为优，中度 NMB 组 16 例（30%）患者手术条件为优。两组均无 PORC 和呼吸并发症，恢复时间及其他不良事件在两组间无差异。
与中度 NMB 并用琥珀酸司可林逆转相比，在 TURB 患者中，深度 NMB 并用琥珀酸司可林逆转可改善内镜手术条件且无并发症。
