دورية أكاديمية
Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery.
| العنوان: | Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery. |
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| المؤلفون: | Honing GHM; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Martini CH; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Olofsen E; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Bevers RFM; Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands., Huurman VAL; Department of Transplant Surgery and Transplant Centre, Leiden University Medical Centre, Leiden, The Netherlands., Alwayn IPJ; Department of Transplant Surgery and Transplant Centre, Leiden University Medical Centre, Leiden, The Netherlands., van Velzen M; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Niesters M; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Aarts LPHJ; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Dahan A; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Boon M; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: m.boon@lumc.nl. |
| المصدر: | British journal of anaesthesia [Br J Anaesth] 2021 Feb; Vol. 126 (2), pp. 377-385. Date of Electronic Publication: 2020 Oct 20. |
| نوع المنشور: | Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 0372541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-6771 (Electronic) Linking ISSN: 00070912 NLM ISO Abbreviation: Br J Anaesth Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : [London] : Elsevier Original Publication: London, Eng. [etc.] |
| مواضيع طبية MeSH: | Laparoscopy*/adverse effects , Nephrectomy*/adverse effects , Neuromuscular Blockade*/adverse effects , Surgeons*, Anesthetics, Inhalation/*administration & dosage , Kidney/*surgery , Sevoflurane/*administration & dosage, Adult ; Aged ; Aged, 80 and over ; Double-Blind Method ; Female ; Humans ; Intraoperative Neurophysiological Monitoring ; Male ; Middle Aged ; Netherlands ; Neuromuscular Monitoring ; Prospective Studies ; Treatment Outcome ; Young Adult |
| مستخلص: | Background: Deep neuromuscular block is associated with improved working conditions during laparoscopic surgery when propofol is used as a general anaesthetic. However, whether deep neuromuscular block yields similar beneficial effects when anaesthesia is maintained using volatile inhalation anaesthesia has not been systematically investigated. Volatile anaesthetics, as opposed to intravenous agents, potentiate muscle relaxation, which potentially reduces the need for deep neuromuscular block to obtain optimal surgical conditions. We examined whether deep neuromuscular block improves surgical conditions over moderate neuromuscular block during sevoflurane anaesthesia. Methods: In this single-centre, prospective, randomised, double-blind study, 98 patients scheduled for elective renal surgery were randomised to receive deep (post-tetanic count 1-2 twitches) or a moderate neuromuscular block (train-of-four 1-2 twitches). Anaesthesia was maintained with sevoflurane and titrated to bispectral index values between 40 and 50. Pneumoperitoneum pressure was maintained at 12 mm Hg. The primary outcome was the difference in surgical conditions, scored at 15 min intervals by one of eight blinded surgeons using a 5-point Leiden-Surgical Rating Scale (L-SRS) that scores the quality of the surgical field from extremely poor 1 to optimal 5 . Results: Deep neuromuscular block did not improve surgical conditions compared with moderate neuromuscular block: mean (standard deviation) L-SRS 4.8 (0.3) vs 4.8 (0.4), respectively (P=0.94). Secondary outcomes, including unplanned postoperative readmissions and prolonged hospital admission, were not significantly different. Conclusions: During sevoflurane anaesthesia, deep neuromuscular block did not improve surgical conditions over moderate neuromuscular block in normal-pressure laparoscopic renal surgery. Clinical Trial Registration: NL7844 (www.trialregister.nl). (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Leiden-Surgical Rating Scale; laparoscopic surgery; neuromuscular block; propofol; sevoflurane; surgical conditions; volatile anaesthesia |
| المشرفين على المادة: | 0 (Anesthetics, Inhalation) 38LVP0K73A (Sevoflurane) |
| تواريخ الأحداث: | Date Created: 20201023 Date Completed: 20210201 Latest Revision: 20210201 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC7572301 |
| DOI: | 10.1016/j.bja.2020.09.024 |
| PMID: | 33092803 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1471-6771 |
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| DOI: | 10.1016/j.bja.2020.09.024 |