Neuromuscular blockade improves surgical conditions (NISCO)
Neuromuscular blockade improves surgical conditions (NISCO)
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DOI：
10.1007/s00464-014-3711-7
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发表时间：
2015-03-01
影响因子：
3.1
通讯作者：
Fink, Heidrun
中科院分区：
文献类型：
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作者：
Blobner, Manfred;Frick, Christiane G.;Fink, Heidrun
我们研究了平衡麻醉下择期腹腔镜胆囊切除术中肌肉放松对手术条件和患者术后结果的影响。经批准同意后，57例麻醉患者随机分为无神经肌肉阻断组（no NMB）和深度神经肌肉阻断组（deep NMB），即对四次神经训练刺激无抽搐反应。腹腔镜胆囊切除术采用4套管针技术和co2气腹。使用视觉模拟量表评估手术条件。膈肌或腹肌运动，能见度不足，或对着呼吸机呼吸和咳嗽被记录为肌肉松弛不充分的事件。独立地，外科医生可以要求0.3 mg/kg罗库溴铵来改善手术条件。获得工作流程变量作为手术条件的替代。数据以平均值表示（95%置信区间）。该试验已在ClinicalTrials.gov注册（NCT00895778）。“No NMB”组25例患者中有12例出现了一个或多个不良事件，影响了手术过程（p < 0.001），而“Deep NMB”组25例患者中只有1例出现了不良事件。深度NMB的绝对风险降低率分别为0.44（0.23-0.65）和2.3（1.5-4.4）。仅“No NMB”组25例中有10例（40%）的外科医生要求0.3 mg/kg罗库溴铵。这一剂量显著改善了手术条件，平均提高了62分（满分100分）。所有进一步的变量在组间没有差异。深度NMB通过提高可视性和减少不自主运动改善腹腔镜胆囊切除术的手术条件。
We examined the impact of muscle relaxation on surgical conditions and patients' postoperative outcome during elective laparoscopic cholecystectomy under balanced anaesthesia.After approval and consent, 57 anaesthetized patients were randomly assigned to group no neuromuscular blockade (No NMB) and deep neuromuscular blockade (Deep NMB), i.e. no twitch response to train-of-four nerve stimulation. Laparoscopic cholecystectomy was performed using the 4-trocar technique with a CO2-pneumoperitoneum. Surgical conditions were assessed using a Visual Analogue Scale. Movement of diaphragm or abdominal muscles, inadequate visibility, or breathing and coughing against the ventilator were documented as events reflecting inadequate muscle relaxation. Independently, surgeons could request 0.3 mg/kg rocuronium to improve surgical conditions. Workflow variables were obtained as a surrogate of surgical conditions. Data are presented as mean (95 % confidence interval). The trial is registered at ClinicalTrials.gov (NCT00895778).While in 12 of 25 patients of group "No NMB" one or more adverse events impaired the surgical procedure (p < 0.001), only 1 of 25 patients of group "Deep NMB" showed an adverse event. Deep NMB resulted in an absolute risk reduction of 0.44 (0.23-0.65) and a number needed to treat of 2.3 (1.5-4.4), respectively. Surgeons requested 0.3 mg/kg rocuronium in 10 of 25 cases (40 %) of group "No NMB" only. This dose significantly improved surgical conditions by an average 62 of 100 possible points. All further variables did not differ between groups.Deep NMB ameliorates surgical conditions for laparoscopic cholecystectomy by improved visibility and reduction of involuntary movements.