AI Article Synopsis
- A study investigated whether deep or moderate neuromuscular blockade (NMB) is more effective during thoracoscopic lobectomy surgery, with patients randomly assigned to either NMB level while under intravenous anesthesia.
- Results showed that surgeons applied additional muscle relaxant significantly more often in patients with moderate NMB (44.8%) compared to those with deep NMB (0%), leading to higher surgeon satisfaction in the deep NMB group.
- Recovery times were similar between groups for most measures, but deep NMB resulted in a quicker recovery to 25% and 90% TOF levels by an average of 10 minutes.
Article Abstract
Background: Laparoscopic surgery typically requires deep neuromuscular blockade (NMB), but whether deep or moderate NMB is superior for thoracoscopic surgery remains controversial.
Methods: Patients scheduled for thoracoscopic lobectomy under intravenous anesthesia were randomly assigned to receive moderate [train of four (TOF) 1-2] or deep NMB [TOF 0, post-tetanic count (PTC) 1-5]. Depth of anesthesia was controlled at a Narcotrend rating of 30 ± 5 in both groups. The primary outcome was the need to use an additional muscle relaxant (cisatracurium) during surgery. Secondary outcomes included surgeon satisfaction, recovery time of each stage after drug withdrawal [time from withdrawal until TOF recovery to 20% (antagonists administration), 25, 75, 90, 100%], blood gas data, VAS pain grade after extubation, the time it takes for patients to begin walking after surgery, postoperative complications and hospitalization time. Results were analyzed on an intention-to-treat basis.
Results: Thirty patients were enrolled per arm, and all but one patient in each arm was included in the final analysis. Among patients undergoing moderate NMB, surgeons applied additional cisatracurium in 8 patients because of body movement and 5 because of coughing (13/29, 44.8%). Additional cisatracurium was not applied to any of the patients undergoing deep NMB (p < 0.001). Surgeons reported significantly higher satisfaction for patients undergoing deep NMB (p < 0.001, Wilcoxon rank sum test). The mean difference between the two groups in the time from withdrawal until TOF recovery of 25% or 90% was 10 min (p < 0.001). The two groups were similar in other recovery data, blood gas analysis, VAS pain grade, days for beginning to walk and mean hospitalization time.
Conclusions: Deep NMB can reduce the use of additional muscle relaxant and increase surgeon satisfaction during thoracoscopic lobectomy.
Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IOR-15007117 , 22 September 2015.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303978 | PMC |
| http://dx.doi.org/10.1186/s12871-018-0666-6 | DOI Listing |
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