Abstract
Objective
Robot-assisted radical prostatectomy (RARP) requires pneumoperitoneum (Pnp) and a steep head-down position that may disturb respiratory system compliance (Crs) during surgery. Our aim was to compare the effects of different degrees of neuromuscular block (NMB) on Crs with the same Pnp pressure during RARP. Methods: One hundred patients who underwent RARP were enrolled and randomly allocated to a deep or moderate NMB group with 50 patients in each group. Rocuronium was administered to both groups: in the moderate NMB group to maintain 1–2 responses to train-of-four (TOF) stimulation; and in the deep NMB group to maintain no response to TOF stimulation and 1–2 responses in the post-tetanic count. Pnp pressure in both groups was 10 mmHg (1 mmHg=133.3 Pa). Peak inspiratory pressure (Ppeak), mean pressure (Pmean), Crs, and airway resistance (Raw) were recorded after anesthesia induction and at 0, 30, 60, and 90 min of Pnp and post-Pnp. Surgical space conditions were evaluated after the procedure on a 4-point scale.
Results
Immediately after the Pnp, Ppeak, Pmean, and Raw significantly increased, while Crs decreased and persisted during Pnp in both groups. The results did not significantly differ between the two groups at any of the time points. There was no difference in surgical space conditions between groups. Body movements occurred in 14 cases in the moderate NMB group and in one case in the deep NMB group, and all occurred during obturator lymphadenectomy. A significant difference between the two groups was observed.
Conclusions
Under the same Pnp pressure in RARP, deep and moderate NMBs resulted in similar changes in Crs, and in other respiratory mechanics and surgical space conditions. However, deep NMB significantly reduced body movements during surgery.
摘 要
目 的
机器人辅助前列腺癌根治术中需要头低位和气腹, 这将严重干扰呼吸顺应性 (Crs). 本研究比 较机器人辅助腹腔镜前列腺癌根治术在相同气腹压力下不同程度的神经肌肉阻滞对Crs 的影响.
创新点
不同深度神经肌肉阻滞对机器人辅助前列腺癌根治术 Crs 的观察.
方 法
将 100 例接受机器人辅助腹腔镜前列腺癌根治术的患者随机分配到中度神经肌肉阻滞组和深度神经肌肉阻滞组, 每组 50 例. 应用罗库溴铵维持神经肌肉阻滞. 保持对 4 个成串刺激 1–2 个反 应为中度神经肌肉阻滞组; 对 4 个成串刺激无反应, 而对强直后刺激 1–2 个反应为深度神经肌肉阻滞组. 两组气腹压力均为 10 mmHg. 记录麻醉诱导后及气腹 0、 30、 60 和 90 min 的吸气峰值压力、 平均压力、 Crs 和气道阻力. 手术结束时对手术条件进行评估.
结 论
在机器人辅助腹腔镜前列腺癌根治术中, 相同的气腹压力下, 深度神经肌肉阻滞不能改善 Crs 和手术条件, 但能显著降低术中体动.
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Shao-jun ZHU, Xiao-lin ZHANG, and Qing XIE collected and analyzed the data. Shao-jun ZHU and Kui-rong WANG wrote the manuscript. Yan-feng ZHOU and Kui-rong WANG designed the study and edited the manuscript. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Shao-jun ZHU, Xiao-lin ZHANG, Qing XIE, Yan-feng ZHOU, and Kui-rong WANG declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). This study was approved by the Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China), and written informed consent was obtained from all enrolled patients. The trial was registered prior to patient enrolment with the Chinese Clinical Trial Registry (No. ChiCTR1800017660; date of registration: Aug. 1, 2018).
Additional information
Project supported by the Zhejiang Province Public Welfare Technology Application Research Project (No. LGF20H010006), China
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Zhu, Sj., Zhang, Xl., Xie, Q. et al. Comparison of the effects of deep and moderate neuromuscular block on respiratory system compliance and surgical space conditions during robot-assisted laparoscopic radical prostatectomy: a randomized clinical study. J. Zhejiang Univ. Sci. B 21, 637–645 (2020). https://doi.org/10.1631/jzus.B2000193
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DOI: https://doi.org/10.1631/jzus.B2000193
Key words
- Robot-assisted radical prostatectomy (RARP)
- Deep neuromuscular block
- Respiratory mechanics
- Surgical space condition