Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial
Abstract Background In recent years, the relationship between the advantages and disadvantages of a deep neuromuscular block (DNMB), compared to a moderate block (MNMB) in laparoscopic surgery, has been increasingly studied. Objective Evaluate the effect of D-NMB compared to M-NMB in gynecological l...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-023-00086-7 |
| _version_ | 1828056643492904960 |
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| author | Antonio Coviello Marilena Ianniello Pasquale Buonanno Nausica Di Falco Carmine Iacovazzo Alfredo Maresca Maria Vargas Annachiara Marra Agostino Candice Gabriele Saccone Fulvio Zullo Giuseppe Servillo |
| author_facet | Antonio Coviello Marilena Ianniello Pasquale Buonanno Nausica Di Falco Carmine Iacovazzo Alfredo Maresca Maria Vargas Annachiara Marra Agostino Candice Gabriele Saccone Fulvio Zullo Giuseppe Servillo |
| author_sort | Antonio Coviello |
| collection | DOAJ |
| description | Abstract Background In recent years, the relationship between the advantages and disadvantages of a deep neuromuscular block (DNMB), compared to a moderate block (MNMB) in laparoscopic surgery, has been increasingly studied. Objective Evaluate the effect of D-NMB compared to M-NMB in gynecological laparoscopic surgery. Methods This was a parallel-group, double-blind, randomized clinical trial, conducted at a single center in Italy between February 2020 and July 2020. American Society of Anesthesiologist (ASA) I–II risk class patients scheduled for elective gynecological laparoscopic surgery were randomized into a 1:1 ratio to either experimental or control group. The first one included DNMB with a rocuronium bolus at the starting dose of 1.2 mg/kg and a maintenance dose (0.3–0.6 mg/kg/h). The second one included MNMB with a rocuronium bolus at the starting dose of 0.6 mg/kg, and a maintenance dose in boluses (0.15–0.25 mg/kg). The primary outcome was the intraoperative surgical condition assessed every 15 min by the surgeon as a 5-point scale. The secondary outcome was the time needed to discharge patients from post-anesthesia care unit (PACU). The tertiary outcome was the assessment of the intra-operative hemodynamic instability. A sample size of 50 patients was planned. Results One hundred five patients were assessed for eligibility, 55 were excluded. Fifty patients met the inclusion criteria and were enrolled. The average score for the operative field was 4 for the D-NMB group and 3 for the M-NMB group (p value < 0.01). The length of stay in PACU was 13 min for the DNMB group and 22 min for the MNMB group (p value = 0.02). Conclusions Deep neuromuscular block improves intraoperative surgical condition during gynecological laparoscopic surgery. Trial registration clinicalTrials.gov NCT03441828 |
| first_indexed | 2024-04-10T20:58:49Z |
| format | Article |
| id | doaj.art-68db1c32bff041d3b187e57b0c8c0350 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-04-10T20:58:49Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-68db1c32bff041d3b187e57b0c8c03502023-01-22T12:28:25ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862023-01-01311810.1186/s44158-023-00086-7Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trialAntonio Coviello0Marilena Ianniello1Pasquale Buonanno2Nausica Di Falco3Carmine Iacovazzo4Alfredo Maresca5Maria Vargas6Annachiara Marra7Agostino Candice8Gabriele Saccone9Fulvio Zullo10Giuseppe Servillo11Department of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityDepartment of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II UniversityAbstract Background In recent years, the relationship between the advantages and disadvantages of a deep neuromuscular block (DNMB), compared to a moderate block (MNMB) in laparoscopic surgery, has been increasingly studied. Objective Evaluate the effect of D-NMB compared to M-NMB in gynecological laparoscopic surgery. Methods This was a parallel-group, double-blind, randomized clinical trial, conducted at a single center in Italy between February 2020 and July 2020. American Society of Anesthesiologist (ASA) I–II risk class patients scheduled for elective gynecological laparoscopic surgery were randomized into a 1:1 ratio to either experimental or control group. The first one included DNMB with a rocuronium bolus at the starting dose of 1.2 mg/kg and a maintenance dose (0.3–0.6 mg/kg/h). The second one included MNMB with a rocuronium bolus at the starting dose of 0.6 mg/kg, and a maintenance dose in boluses (0.15–0.25 mg/kg). The primary outcome was the intraoperative surgical condition assessed every 15 min by the surgeon as a 5-point scale. The secondary outcome was the time needed to discharge patients from post-anesthesia care unit (PACU). The tertiary outcome was the assessment of the intra-operative hemodynamic instability. A sample size of 50 patients was planned. Results One hundred five patients were assessed for eligibility, 55 were excluded. Fifty patients met the inclusion criteria and were enrolled. The average score for the operative field was 4 for the D-NMB group and 3 for the M-NMB group (p value < 0.01). The length of stay in PACU was 13 min for the DNMB group and 22 min for the MNMB group (p value = 0.02). Conclusions Deep neuromuscular block improves intraoperative surgical condition during gynecological laparoscopic surgery. Trial registration clinicalTrials.gov NCT03441828https://doi.org/10.1186/s44158-023-00086-7Gynecologic surgeryLaparoscopic surgeryNeuromuscular blockClinical trialPost-anesthesia care unitPACU |
| spellingShingle | Antonio Coviello Marilena Ianniello Pasquale Buonanno Nausica Di Falco Carmine Iacovazzo Alfredo Maresca Maria Vargas Annachiara Marra Agostino Candice Gabriele Saccone Fulvio Zullo Giuseppe Servillo Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial Journal of Anesthesia, Analgesia and Critical Care Gynecologic surgery Laparoscopic surgery Neuromuscular block Clinical trial Post-anesthesia care unit PACU |
| title | Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial |
| title_full | Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial |
| title_fullStr | Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial |
| title_full_unstemmed | Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial |
| title_short | Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial |
| title_sort | effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery a randomized clinical trial |
| topic | Gynecologic surgery Laparoscopic surgery Neuromuscular block Clinical trial Post-anesthesia care unit PACU |
| url | https://doi.org/10.1186/s44158-023-00086-7 |
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