Objective monitoring of neuromuscular transmission in laparoscopic surgery

Abstract

Aim. To assess the importance of quantitative neuromuscular transmission monitoring in laparoscopic surgery. Methods. 30 patients [11 (37.7%) males, 19 (63.3%) females, mean age 52.3±7.18 years] who underwent laparoscopic surgery and general anesthesia associated with skeletal muscles relaxation, were examined. The degree of neuromuscular transmission recovery and time to trachea extubation performed by an anesthetist after the end of surgery (like laparoscopic cholecystectomy, appendectomy) and general anesthesia associated with skeletal muscles relaxation were assessed using quantitative monitoring of neuromuscular transmission and «blind» control. Results. In 21 patients no drugs were used to reverse the skeletal muscles relaxation. Trachea extubation in this group was performed 10.5 minutes after the end of surgery in average at the neuromuscular transmission Train of Four (TOF) level of 43-81% for 15 patients and at the TOF level over 90% in 6 patients. In 9 patients, sugammadex (2 mg/kg) was used for neuromuscular transmission reversal, the average level of neuromuscular blockade (TOF) in those patients was 41±6.5%. TOF average recovery time up to 90% was 1 minute 48 seconds. Trachea extubation was performed no later than 4 minutes after the sugammadex administration. Conclusion. The subjective assessment of neuromuscular transmission recovery, based on the assessment of clinical signs, is not able to completely exclude the residual muscle relaxation. Objective monitoring of neuromuscular transmission is required to determine the time of intubation, administration of maintenance doses of muscle relaxants, and for assessment of efficacy of reversal and possibility for trachea extubation.