目的:在腹腔镜手术中常规使用神经肌肉阻断剂以优化手术条件。我们比较了深度和中度神经肌肉阻滞(NMB)对接受腹腔镜大手术的儿童的手术条件和术后结局的影响。
方法:将60名年龄在2-14岁接受腹腔镜大手术的儿童随机分为深度(强直后1-2次抽搐)或中度(4次1-2次抽搐)NMB组。用丙泊酚和瑞芬太尼维持麻醉,并且用罗库溴铵连续输注维持NMB。手术结束时,NMB被sugammadex拮抗。腹内压,气道压力,莱顿外科评定量表,术中血流动力学,药物用法,手术持续时间,术后恢复时间,疼痛,比较两组患者的并发症情况。
结果:最大和平均腹内压,峰值吸气压力,深度NMB组的平均气道压力显著低于中度NMB组(p<0.001)。Leiden手术评定量表和罗库溴铵用量在深NMB组明显高于中度NMB组(p<0.001)。术中血流动力学,手术持续时间,术后恢复时间,疼痛,两组间并发症发生率差异无统计学意义(p>0.05)。
结论:在接受大型腹腔镜手术的儿童中,与sugamadex逆转的中度NMB相比,深度NMB提供了更好的手术条件和相似的恢复情况。
背景:中国临床试验注册中心,不。ChiCTR2100053821。
OBJECTIVE: Neuromuscular blocking agents are routinely used in laparoscopic surgery to optimize operative conditions. We compared the effect of a deep and moderate neuromuscular blockade (NMB) on surgical conditions and postoperative outcomes in children undergoing major laparoscopic surgery.
METHODS: Sixty children aged 2-14 years scheduled to undergo major laparoscopic surgery were randomly allocated to deep (post-tetanic count 1-2 twitches) or moderate (train-of-four 1-2 twitches) NMB groups. The anesthesia was maintained with propofol and remifentanil, and the NMB was maintained with a rocuronium continuous infusion. At the end of the operation, the NMB were antagonized with sugammadex. The intra-abdominal pressure, airway pressure, Leiden Surgical Rating Scale, intraoperative hemodynamics, drug usages, duration of surgery, postoperative recovery time, pain, and complications were compared between the groups.
RESULTS: The maximum and mean intra-abdominal pressure, the peak inspiratory pressure, and mean airway pressure were significantly lower in the deep NMB group than in the moderate NMB group (p < 0.001). The Leiden Surgical Rating Scale and the dosage of rocuronium were significantly higher in the deep NMB group than the moderate NMB group (p < 0.001). The intraoperative hemodynamics, duration of surgery, post-operative recovery time, pain, and the incidence rate of complications were not significantly different between the groups (p > 0.05).
CONCLUSIONS: A deep NMB provided better operative conditions and similar recovery profiles compared with a moderate NMB as reversed with sugammadex in children undergoing major laparoscopic surgery.
BACKGROUND: Chinese Clinical Trial Registry, No. ChiCTR2100053821.