Abstract
Attenuating the intraoperative stress response is crucial; however, the effect of neuromuscular blockade (NMB) on surgical stress is not completely understood. We aimed to investigate the effects of NMB on the perioperative stress response during robot-assisted gastrectomy. Patients were assigned to the deep or moderate NMB group. Serum cortisol, prolactin, and interleukin-6 (IL-6) levels and natural killer (NK) cell percentage were measured before anesthesia induction, 90 min after pneumoperitoneum, operation end (OPEnd), and postoperative day 1. Additionally, C-reactive protein (CRP) and albumin levels were estimated. Additionally, intraoperative heart rate variability was evaluated. The deep NMB group showed significantly lower levels of low-frequency/high-frequency (HF) ratio at OPEnd compared to the moderate NMB group (1.4 ± 0.2 vs. 2.2 ± 0.3, respectively; Bonferroni corrected p = 0.039). Furthermore, HF power in the deep NMB group was significantly higher at OPEnd than that in the moderate NMB group (45.2 ± 3.6 vs. 33.8 ± 4.0, respectively; Bonferroni corrected p = 0.044). However, no significant differences in cortisol, prolactin, IL-6, CRP, and albumin levels and NK cell percentage were found between the two groups. The degree of NMB may have similar effects on stress-related biological markers in patients undergoing robot-assisted gastrectomy.
Highlights
Stomach cancer is a major cause of cancer-associated deaths worldwide, and surgical resection is considered the most effective treatment strategy [1,2]
Of the 46 patients assessed for eligibility, none met the criteria for exclusion
Based on the results of intraoperative heart rate variability (HRV), the deep neuromuscular blockade (NMB) group retained significantly greater autonomic nervous system balance than did the moderate NMB group; no significant differences were found in the levels of stress response-related biological markers including cortisol, prolactin, IL-6 levels, and natural killer (NK) cell percentage
Summary
Stomach cancer is a major cause of cancer-associated deaths worldwide, and surgical resection is considered the most effective treatment strategy [1,2]. Robot-assisted gastrectomy has been increasingly regarded as a minimally invasive alternative This technique requires carbon dioxide (CO2 ) pneumoperitoneum over 12 mmHg and recommends patients to be in the head-up position for the duration of the surgery for better surgical view, both of which are predisposing conditions for autonomic nervous system imbalance. This situation causes stimulation of sympathetic activity, aggravating the perioperative stress response [3,4,5]. Attenuating the intraoperative stress response is especially important in cancer surgeries, as the patients have a compromised immune function [8,9]
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