Soltesz Stefan, Mathes Alexander, Anapolski Michael, Noé Karl Guenter
Department of Anesthesia and Intensive Care, Rheinland Klinikum Dormagen, 41540 Dormagen, Germany.
Department of Anesthesia and Intensive Care Medicine, University Hospital of Cologne, 50924 Cologne, Germany.
J Clin Med. 2020 Apr 10;9(4):1078. doi: 10.3390/jcm9041078.
The influence of the degree of a neuromuscular block (NMB) on surgical operating conditions during laparoscopic surgery is debated controversially. The extent of abdominal distension during the time course of the NMB was assessed as a new measurement tool. In 60 patients scheduled for gynecologic laparoscopic surgery, the increase of the abdominal wall length induced by the capnoperitoneum was measured at 5 degrees of the NMB: intense NMB-post-tetanic count (PTC) = 0; deep NMB-train-of-four count (TOF) = 0 and PTC = 1-5; medium NMB-PTC > 5 and TOF = 0-1; shallow NMB-TOF > 1; full recovery-train-of-four ratio TOFR > 90%. Simultaneously, the quality of operating conditions was assessed with a standardized rating scale (SRS) reaching from 1 (extremely poor conditions) to 5 (excellent conditions). Fifty patients could be included in the analysis. The abdominal wall length increased by 10-13 mm induced by the capnoperitoneum. SRS was higher during intense NMB (4.7 ± 0.5) vs. full recovery (4.5 ± 0.5) (mean ± SD; = 0.025). Generally, an intense NMB did not increase abdominal wall length induced by capnoperitoneum. Additionally, its influence on the quality of surgical operating conditions seems to be of minor clinical relevance.
神经肌肉阻滞（NMB）程度对腹腔镜手术中手术操作条件的影响存在争议。在NMB过程中，将腹胀程度评估为一种新的测量工具。在60例计划进行妇科腹腔镜手术的患者中，在5个NMB程度下测量了气腹引起的腹壁长度增加：深度NMB-强直后计数（PTC）=0；深度NMB-四个成串刺激计数（TOF）=0且PTC=1-5；中度NMB-PTC>5且TOF=0-1；浅度NMB-TOF>1；完全恢复-四个成串刺激比值（TOFR）>90%。同时，使用标准化评分量表（SRS）评估手术操作条件质量，评分范围为1（条件极差）至5（条件极佳）。50例患者可纳入分析。气腹引起的腹壁长度增加10-13毫米。深度NMB期间的SRS（4.7±0.5）高于完全恢复期间（4.5±0.5）（平均值±标准差；P=0.025）。一般来说，深度NMB不会增加气腹引起的腹壁长度。此外，其对手术操作条件质量的影响似乎在临床上相关性较小。
