Abstract
The influence of the degree of a neuromuscular block (NMB) on surgical operating conditions during laparoscopic surgery is debated controversially. The extent of abdominal distension during the time course of the NMB was assessed as a new measurement tool. In 60 patients scheduled for gynecologic laparoscopic surgery, the increase of the abdominal wall length induced by the capnoperitoneum was measured at 5 degrees of the NMB: intense NMB—post-tetanic count (PTC) = 0; deep NMB—train-of-four count (TOF) = 0 and PTC = 1–5; medium NMB—PTC > 5 and TOF = 0–1; shallow NMB—TOF > 1; full recovery—train-of-four ratio TOFR > 90%. Simultaneously, the quality of operating conditions was assessed with a standardized rating scale (SRS) reaching from 1 (extremely poor conditions) to 5 (excellent conditions). Fifty patients could be included in the analysis. The abdominal wall length increased by 10–13 mm induced by the capnoperitoneum. SRS was higher during intense NMB (4.7 ± 0.5) vs. full recovery (4.5 ± 0.5) (mean ± SD; p = 0.025). Generally, an intense NMB did not increase abdominal wall length induced by capnoperitoneum. Additionally, its influence on the quality of surgical operating conditions seems to be of minor clinical relevance.
Highlights
During laparoscopic surgery, insufflation of carbon dioxide (CO2) creates a space enabling the surgeon to perform the operation
Many studies examined the influence of the neuromuscular block (NMB) on the quality of operating conditions [1,2,3,4,5,6,7,8,9,10]
The primary outcome parameter was the association between the NMB and the increase of the abdominal wall length in longitudinal direction induced by the capnoperitoneum
Summary
Insufflation of carbon dioxide (CO2) creates a space enabling the surgeon to perform the operation. Intraabdominal measurements, e.g., of abdominal volume, were performed [2,5,6], and several scores were developed [4,8,11]. Assessing operating conditions objectively proved to be a difficult task, which might be a reason for differing results with respect to the degree of NMB required. The objective of this study was to assess the association of the NMB on abdominal distension and operating conditions. To obtain a reliable parameter and a new measurement tool for this purpose, the degree of abdominal distension during the time course of the NMB was assessed and compared with a standardized score (surgical rating score, SRS) [8]. The primary outcome parameter was the association between the NMB and the increase of the abdominal wall length in longitudinal direction induced by the capnoperitoneum. We hypothesized that an increasing degree of the NMB would correspond to an increase in length of the abdominal wall length
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