Effect of Neuromuscular Blockade on Intraoperative Respiratory Mechanics and Surgical Space Conditions during Robot-Assisted Radical Prostatectomy: A Prospective Randomized Controlled Trial.

Chang-Hoon Koo,Sangchul Lee,Insun Park,Jung-Hee Ryu,Sungmin Ahn

doi:10.3390/jcm10215090

Abstract

The aim of this study was to investigate whether deep neuromuscular blockade (NMB) may affect intraoperative respiratory mechanics, surgical condition, and recovery profiles in patients undergoing robot-assisted radical prostatectomy (RARP). Patients were randomly assigned to the moderate or deep NMB groups. Pneumoperitoneum was maintained with carbon dioxide (CO2) insufflation at 15 mmHg during surgery. The primary outcome was peak inspiratory pressure (PIP) after CO2 insufflation. Mean airway pressure (Pmean) and dynamic lung compliance (Cdyn) were also recorded. The surgeon rated the surgical condition and surgical difficulty on a five-point scale (1 = extremely poor; 2 = poor; 3 = acceptable; 4 = good; 5 = optimal). Recovery profiles, such as pulmonary complications, pain scores, and recovery time, were recorded. We included 58 patients in this study. No significant differences were observed regarding intraoperative respiratory mechanics including PIP, Pmean and Cdyn, between the two groups. The number of patients with optimal surgical conditions was significantly higher in the deep than in the moderate NMB group (29 vs. 20, p = 0.014). We found no differences in recovery profiles. In conclusion, deep NMB had no significant effect on the intraoperative respiratory mechanics but resulted in optimal endoscopic surgical conditions during RARP compared with moderate NMB.

Highlights

Introduction published maps and institutional affilRobot-assisted laparoscopic radical prostatectomy (RARP) is a representative robotassisted surgery usinghigh-pressure carbon dioxide (CO2 ) for insufflation into the abdominal cavity, to ensure the visibility of the operative field and to protect other organs
This study revealed that deep neuromuscular blockade (NMB) had no significant effect on the peak inspiratory pressure (PIP), Pmean, Cdyn, or oxygenation
The number of optimal surgical conditions was significantly higher in the deep NMB group than in the moderate NMB group, with a similar level of surgical difficulty in both groups

Summary

Introduction

Introduction published maps and institutional affilRobot-assisted laparoscopic radical prostatectomy (RARP) is a representative robotassisted surgery usinghigh-pressure carbon dioxide (CO2 ) for insufflation into the abdominal cavity, to ensure the visibility of the operative field and to protect other organs. To perform RARP using a transperitoneal approach, it is necessary to maintain a steep Trendelenburg position to expose the bladder and the prostate. This surgical position moves the diaphragm toward the head, and may cause excessive peak inspiratory pressure (PIP). Barotrauma in the lung parenchyma in patients on mechanical ventilation [1]. Respiratory mechanics may be impaired, such as a decrease in functional residual capacity and lung compliance [2]. Respiratory impairments can persist for up to 24 h after surgery, delaying patient recovery [3].

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Conclusion