Department of Anaesthesiology, Radboudumc, Route 717, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands.
Department of Urology, Radboudumc, Nijmegen, the Netherlands.
BMC Anesthesiol. 2023 Jul 14;23(1):238. doi: 10.1186/s12871-023-02201-1.
Conflicting data exist regarding the effects of deep neuromuscular blockade (NMB) on abdominal dimensions during laparoscopic procedures. We performed a clinical study to establish the influence of moderate and deep neuromuscular blockade (NMB) on the abdominal working space, measured by Magnetic Resonance Imaging (MRI), during laparoscopic donor nephrectomy with standard pressure (12 mmHg) pneumoperitoneum under sevoflurane anaesthesia.
Ten patients were intraoperatively scanned three times in the lateral decubitus position, with pneumoperitoneum maintained by a mobile insufflator. The first scan without NMB (T1) was followed by scans with moderate (T2) and deep NMB (T3). The skin-sacral promontory (S-SP) distance was measured, and 3D pneumoperitoneum volumes were reconstructed.
The mean difference in the S-SP distance was -0.32 cm between T2 and T3 (95% CI -1.06 - 0.42 cm; p = 0.344) and + 2.1 cm between T1 and T2 (95% CI 0.81 - 3.39 cm; p = 0.006). The mean differences in pneumoperitoneum volume were 166 mL between T2 and T3 (95% CI, 5 - 327 mL; p = 0.044) and 108 mL between T1 and T2 (95% CI, -273 - 488 mL; p = 0.525). The pneumoperitoneum volume showed high inter-individual variability and no increase in three patients with a high volume at T1.
During laparoscopic surgery in the lateral decubitus position with standard pressure under sevoflurane anaesthesia, deep NMB did not increase the S-SP distance compared to moderate NMB. Moderate NMB increased the S-SP distance by a mean of 2.1 cm (15.2%) compared with no NMB. The mean pneumoperitoneum volume increased slightly from moderate to deep NMB, with high inter-individual variability.
Clinicaltrials.gov ID: NCT03287388.
关于深度神经肌肉阻滞（NMB）对腹腔镜手术中腹部尺寸的影响，存在相互矛盾的数据。我们进行了一项临床研究，以确定在七氟醚麻醉下标准压力（12mmHg）气腹腹腔镜供肾切术中，中度和深度 NMB 对磁共振成像（MRI）测量的腹部工作空间的影响。
10 名患者在侧卧位时进行了 3 次术中扫描，使用移动注气器维持气腹。第一次无 NMB（T1）扫描后，进行中度（T2）和深度 NMB（T3）扫描。测量皮肤-骶骨突距（S-SP）距离，并重建 3D 气腹体积。
T2 与 T3 之间 S-SP 距离的平均差异为-0.32cm（95%CI-1.06cm-0.42cm;p=0.344），T1 与 T2 之间 S-SP 距离的平均差异为+2.1cm（95%CI0.81cm-3.39cm;p=0.006）。T2 与 T3 之间气腹体积的平均差异为 166mL（95%CI，5mL-327mL;p=0.044），T1 与 T2 之间气腹体积的平均差异为 108mL（95%CI，-273mL-488mL;p=0.525）。气腹体积个体间差异较大，3 名 T1 体积较高的患者气腹体积无增加。
在七氟醚麻醉下标准压力腹腔镜手术中，与中度 NMB 相比，深度 NMB 并未增加 S-SP 距离。与无 NMB 相比，中度 NMB 使 S-SP 距离平均增加 2.1cm（15.2%）。从中度到深度 NMB，气腹体积略有增加，个体间差异较大。
Clinicaltrials.gov ID：NCT03287388。
