Результаты проспективного рандомизированного пилотного исследования по оценке влияния уровня миорелаксации и режима вентиляции на хирургические условия при выполнении лапароскопических и робот-ассистированных вмешательств

Андрей Андреевич Климов; А. А. Малахова; С. А. Камнев; С. И. Рудницкий; В. В. Субботин

doi:10.21320/1818-474X-2021-2-115-127

No. 2 (2021), SELECTED ISSUES IN ANESTHESIOLOGY

No. 2 (2021)

SELECTED ISSUES IN ANESTHESIOLOGY

A prospective randomized pilot study: The impact of the depth of neuromuscular blockade and modes of mechanical ventilation on surgical conditions during laparoscopic and robotic surgery

Published 02.06.2021

Andrei A. Klimov⁺⁻
A.A. Malakhova⁺⁻
S.A. Kamnev⁺⁻
S.I. Rudnitsky⁺⁻
V.V. Subbotin⁺⁻

Andrei A. Klimov

Moscow Clinical Scientific Center named after Loginov MHD, Moscow, Russia

https://orcid.org/0000-0001-7633-6852

A.A. Malakhova

Moscow Clinical Scientific Center named after Loginov MHD, Moscow, Russia

https://orcid.org/0000-0003-3868-3671

S.A. Kamnev

Ilyinskaya Hospital, Moscow region, Krasnogorsk, Russia

https://orcid.org/0000-0002-4230-4796

S.I. Rudnitsky

Moscow Clinical Scientific Center named after Loginov MHD, Moscow, Russia

https://orcid.org/0000-0001-7458-7893

V.V. Subbotin

Moscow Clinical Scientific Center named after Loginov MHD, Moscow, Russia

https://orcid.org/0000-0002-0921-7199

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Keywords

robotic surgical procedures
neuromuscular blockade
laparoscopy
muscles
surgical conditions
pressure support ventilation

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Klimov A.A., Malakhova A.A., Kamnev S.A., Rudnitsky S.I., Subbotin V.V. A prospective randomized pilot study: The impact of the depth of neuromuscular blockade and modes of mechanical ventilation on surgical conditions during laparoscopic and robotic surgery. Annals of Critical Care. 2021;(2):115-127. doi:10.21320/1818-474X-2021-2-115-127

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Abstract

Introduction. There is controversy in the literature as to whether deep neuromuscular blockade (NMB) improves the surgical conditions during laparoscopic surgery. We hypothesized that moderate NMB can be used with Pressure support ventilation Pro (PSVpro) during laparoscopic and robotic abdominal surgery without compromising the surgical conditions.

Objectives. The aim of the study is to assess the effect of moderate NMB with PSVpro ventilation on surgical conditions during laparoscopic and robotic surgery.

Materials and methods. The study included 36 patients scheduled for elective laparoscopic or robotic abdominal surgery under general anesthesia. All patients were randomized into two groups. Group 1 — moderate NMB and pressure support ventilation — PSVpro (N = 17 people), group 2 — intensive NMB and pressure control ventilation–volume guaranteed — PCV-VG (N = 19 people). Surgical conditions were evaluated using a the 5-point Leiden-Surgical Rating Scale (L-SRS) every 15 minutes. Additionally, the duration of anesthesia and surgery, the consumption of muscle relaxants and the level of intra-abdominal pressure were recorded.

Results. The median of 515 intermediate assessments in both groups was 5 [5; 5] points (minimum 3; maximum 5), no statistically significant differences (p = 0.28). The medians of the final assessments were also 5 [5; 5] points in group 1 (minimum 4; maximum 5) and 5 [5; 5] points in group 2 (minimum 4; maximum 5), no statistically significant differences between groups (p = 0.32). Final scores corresponding to acceptable, poor and extremely poor surgical conditions were not recorded.

Conclusions. The use of moderate NMB with PSVpro mode did not worsen surgical conditions during laparoscopy, but may reduce the consumption of muscle relaxants.

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References

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A prospective randomized pilot study: The impact of the depth of neuromuscular blockade and modes of mechanical ventilation on surgical conditions during laparoscopic and robotic surgery

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A prospective randomized pilot study: The impact of the depth of neuromuscular blockade and modes of mechanical ventilation on surgical conditions during laparoscopic and robotic surgery

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