Turhanoğlu Selim, Tunç Mehmet, Okşar Menekşe, Temiz Muhyittin
Department of Anaesthesiology and Intensive Care, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey.
Department of General Surgery, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey.
Turk J Anaesthesiol Reanim. 2020 Jun;48(3):188-195. doi: 10.5152/TJAR.2019.31855. Epub 2019 Oct 22.
We aimed to investigate the effects of high-dose rocuronium administration on intra-abdominal pressure (IAP) and surgical conditions during anaesthesia induction and laparoscopic cholecystectomy anaesthesia induction, respectively. Further, we aimed to determine postoperative nausea and vomiting (PONV) and pain scores following the laparoscopic cholecystectomy.
Patients with American Society of Anesthesiologists (ASA) score of I-III, aged 18 to 75 years and who were scheduled for surgery under general anaesthesia were included in the study. Patients were randomised and a high-dose of 1.2 mg kg rocuronium was given to Group A and 0.6 mg kg rocuronium to Group B. The intraoperative train of four (TOF) ratio and post-tetanic count (PTC) were measured. Surgery was initiated with a low IAP of 7 mmHg. The surgeon evaluated surgical conditions with a 4-step surgical field scale and increased the IAP when necessary. PONV at 4, 12 and 24 hours and postoperative pain at 2 and 24 hours and 3 days were evaluated.
There were no significant differences in the demographic and haemodynamic parameters between the groups. In high-dose rocuronium Group A, IAP values were significantly lower in the first 20 minutes compared to Group B. The duration of operations was significantly shorter in Group A (29.00±7.39 minute vs. 34.63±12.00 minute, p=0.044). PONV in the first 12 hours was significantly lower in Group A (p<0.05).
High-dose rocuronium-induced deep neuromuscular block helped perform laparoscopic cholecystectomy operations with lower values of IAP compared to a normal dose rocuronium. It also shortened duration of operation and reduced PONV and pain.
我们旨在分别研究大剂量罗库溴铵给药对麻醉诱导期间及腹腔镜胆囊切除术麻醉诱导期间腹内压（IAP）和手术条件的影响。此外，我们旨在确定腹腔镜胆囊切除术后的术后恶心呕吐（PONV）和疼痛评分。
纳入美国麻醉医师协会（ASA）评分I - III级、年龄18至75岁且计划接受全身麻醉手术的患者。患者被随机分组，A组给予1.2 mg/kg的大剂量罗库溴铵，B组给予0.6 mg/kg的罗库溴铵。测量术中四个成串刺激（TOF）比值和强直刺激后计数（PTC）。手术起始时腹内压设定为7 mmHg。外科医生使用4级手术视野量表评估手术条件，并在必要时增加腹内压。评估4、12和24小时的PONV以及2、24小时和3天的术后疼痛情况。
两组之间的人口统计学和血流动力学参数无显著差异。在大剂量罗库溴铵的A组中，与B组相比，前20分钟的IAP值显著更低。A组的手术持续时间显著更短（29.00±7.39分钟对34.63±12.00分钟，p = 0.044）。A组前12小时的PONV显著更低（p<0.05）。
与正常剂量罗库溴铵相比，大剂量罗库溴铵诱导的深度神经肌肉阻滞有助于在较低IAP值下进行腹腔镜胆囊切除术。它还缩短了手术持续时间，降低了PONV和疼痛程度。
