Efficacy of deep neuromuscular blockade combined with low-pressure pneumoperitoneum for gynecological laparoscopic surgery in obese patients

Abstract

Objective To evaluate the efficacy of deep neuromuscular blockade (NMB) combined with low-pressure pneumoperitoneum for gynecological laparoscopic surgery in the obese patients. Methods Sixty obese patients, aged 34-64 yr, with body mass index 28.7-32.0 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective laparoscopic hysterectomy, were allocated into 2 groups (n=30 each) using a random number table method: deep NMB plus low-pressure pneumoperitoneum group (group A) and moderate NMB plus high-pressure pneumoperitoneum group (group B). Cis-atracurium sulfamate was intravenously infused to maintain NMB under monitoring in both group.Group A was to maintain train-of-four (TOF) count of 0, post-tetanic count of 1 or 2, and pneumoperitoneum pressure of 10 mmHg.Group B was to maintain TOF count of 1 or 2 and pneumoperitoneum pressure of 14 mmHg.Satisfaction with surgical field was evaluated.The recovery index and time for TOF ratio returning to 0.7 and 0.9 were recorded.Peak airway pressure was recorded at 5 min before pneumoperitoneum (T0), 5 min of pneumoperitoneum-supine position(T1), 5 min of pneumoperitoneum-surgical position (T2), and 5 min after deflation at the end of surgery (T3). The development of hypoxemia, shoulder pain, and abdominal pain was recorded within 48 h after surgery. Results There was no significant difference in the satisfaction with surgical field between the two groups (P>0.05). Compared with group B, the recovery index and time for TOF ratio returning to 0.7 and 0.9 were significantly prolonged, peak airway pressure was decreased at T1 and T2, and the incidence of postoperative shoulder pain and abdominal pain was decreased in group A (P<0.05). Conclusion Compared with moderate NMB combined with high-pressure pneumoperitoneum, deep NMB combined with low-pressure pneumoperitoneum can provide a satisfactory surgical field and reduce postoperative pain, however, it prolongs the recovery time of NMB for gynecological laparoscopic surgery in the obese patients. Key words: Neuromuscular blockade; Pneumoperitoneum, artificial; Obesity; Laparoscopy