Optimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy--a randomised, blinded crossover study

Acta Anaesthesiologica Scandinavica
Matias V MadsenOlav Istre

Abstract

Insufflation of the abdomen during laparoscopy improves surgical space, but may cause post-operative shoulder pain. The incidence of shoulder pain is reduced using a lower insufflation pressure, but this may, however, compromise the surgical space. We aimed at investigating whether deep neuromuscular blockade (NMB) would enlarge surgical space, measured as the distance from the sacral promontory to the trocar in patients undergoing gynaecologic laparoscopy. Fourteen patients were randomised in an assessor-blinded crossover design. The distance from the sacral promontory to the trocar was measured during deep NMB and without NMB at pneumoperitoneum 8 and 12 mmHg both. Additionally, we assessed surgical conditions while suturing the abdominal fascia using a 4-point subjective rating scale. Deep NMB was established with rocuronium and reversed with sugammadex. At 12 mmHg pneumoperitoneum, deep NMB improved surgical space with a mean of 0.33 cm (95% confidence interval 0.07-0.59) (P=0.01, paired t-test) compared with no NMB. At 8 mmHg pneumoperitoneum deep NMB improved surgical space with a mean of 0.3 cm (95% confidence interval, 0.06-0.54) (P=0.005) compared with no NMB. Deep NMB resulted in significantly better ratings of surgic...Continue Reading

Associated Clinical Trials

Apr 11, 2019·Elena Crescioli

References

Jul 20, 2007·Acta Anaesthesiologica Scandinavica·T Fuchs-BuderUNKNOWN 8th International Neuromuscular Meeting
Sep 11, 2008·Clinical Science·Yuan Ming LuoMichael I Polkey
Jun 23, 2009·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Vismit Pradyumna JoshipuraRashmi Thakker
Sep 16, 2009·Current Opinion in Anaesthesiology·Paul H AlfilleMatthias Eikermann
Jan 24, 2013·Surgical Endoscopy·Anders Meller DonatskyIsmail Gögenur
May 9, 2014·European Journal of Anaesthesiology·Philippe E DuboisOlivier Donnez

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Citations

Feb 13, 2016·Acta Anaesthesiologica Scandinavica·M V MadsenM R Gätke
Feb 6, 2016·Acta Anaesthesiologica Scandinavica·Aaron F Kopman, Mohamed Naguib
Aug 11, 2017·Korean journal of anesthesiology·Hyun Chul ChoSo Ron Choi
Jun 8, 2018·European Journal of Anaesthesiology·Carl M SöderströmMatias V Madsen
Mar 3, 2018·F1000Research·Martijn BoonAlbert Dahan
Mar 3, 2018·Der Anaesthesist·C Unterbuchner, M Blobner
Jul 31, 2019·Anesthesia and Analgesia·Julio C BrandãoMarcos F Vidal Melo
Dec 19, 2015·Anesthesia and Analgesia·Hans D de BoerAlbert Dahan
Dec 19, 2015·Anesthesia and Analgesia·Aaron F Kopman, Mohamed Naguib
Apr 5, 2016·European Journal of Anaesthesiology·Matias Vested MadsenMona Ring Gätke
Nov 20, 2019·Anesthesia and Analgesia·Julio C BrandãoMarcos F Vidal Melo
May 12, 2016·Current Opinion in Anaesthesiology·Claude Meistelman, François Donati
Jul 11, 2018·JMIR Research Protocols·Edoardo De RobertisUNKNOWN Società Italiana Di Anestesia Analgesia Rianimazione E Terapia Intensiva
Oct 28, 2017·British Journal of Anaesthesia·M H BruintjesM C Warlé
Oct 28, 2017·British Journal of Anaesthesia·W H Kim, J-H Bahk
Jan 12, 2020·Anaesthesia Critical Care & Pain Medicine·Benoît PlaudBertrand Debaene

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