Publication details
Does the depth of neuromuscular blockade influence surgical conditions during paediatric laparoscopic surgery? Preliminary results of a randomized controlled study
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| Year of publication | 2017 |
| Type | Conference abstract |
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| Description | Background: Muscle relaxants, including cisatracurium and rocuronium, are a necessary part of laparoscopic surgery even in paediatric patients. The aim of the PedLapBlock trial (NCT02546843) is to investigate whether the depth of the muscle relaxation can improve the quality of the surgical field and thus increase the comfort of the surgeon. Methods: Since February 2016, we have randomly assigned eligible patients between 2 years 0 days and 17 years 364 days of age, who were planned for laparoscopic surgery, in two groups according to the depth of neuromuscular block. Group A received rocuronium (starting dose 0.6 mg/kg, boluses 0.3 mg/kg) to induce and maintain deep neuromuscular block (train-of-four count [TOF] 0 and post-tetanic count [PTC] 1) followed by sugammadex reverse (2-4 mg/kg, depending on TOF). In Group B, intermediate neuromuscular blockade (TOF 1-2) produced by cisatracurium (starting dose 0.15 mg/kg, boluses 0.03 mg/kg) was reversed using neostigmine (0.03 mg/kg) and atropine (0.02 mg/kg). To asses surgical conditions during laparoscopy, a 5-point scoring system (from 1=optimal to 5=extremely poor conditions) was adopted. Means were compared using t-test. Results: As of December 7, 2016, 20 patients were evaluated (mean age 13.5 years [range 5-17]; mean weight 53.3 kg [range 20-90]; median ASA score 1 [range 1-2]; median Mallampati score 1 [range 1-2]). Types of surgical procedures comprised appendectomy (n=16), splenectomy (n=1), pyeloplasty (n=2), and cholecystectomy (n=1). Satisfaction of surgeons, as measured by the 5-point scoring system, was comparable between the two study arms (mean: 1.4±0.7 vs 1.2±0.4 in Groups A vs B, p=0.43). Mean capnoperitoneum pressure and duration were 9.7 mmHg [range 7-12] and 39.5 min [range 14-188], respectively, with a tendency towards lower pressures in Group A (mean: 9.1±1.1 vs 10.1±1.3, p=0.08). The mean time to first EtCO2 wave was significantly shorter in Group A (118.3±36.2 s) compared with Group B (177.5±45.5 s, p<0.01). When looking at the time from the last skin stitch to extubation, roughly corresponding to recovery time from neuromuscular block, the difference also reached statistical significance (mean: 683.4±214.5 vs 1045.8±322.4 s in Groups A vs B, p=0.02). Conclusion: The presented preliminary results show that both levels of neuromuscular blockade (deep versus intermediate) are feasible in paediatric patients undergoing laparoscopic surgery. |