腹腔镜结直肠手术地氟醚麻醉期间，深层神经肌肉阻滞对术中 NOL 引导下瑞芬太尼需求量的影响：随机对照试验。

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-10-23 DOI:10.1016/j.jclinane.2024.111659

Louis Morisson , Hakim Harkouk , Alexandra Othenin-Girard , Walid Oulehri , Pascal Laferrière-Langlois , Marie-Eve Bélanger , Moulay Idrissi , Nadia Godin , Olivier Verdonck , Louis-Philippe Fortier , Madeleine Poirier , Margaret Henri , Jean-François Latulippe , Jean-François Tremblay , Jean-Sebastien Trépanier , Yves Bendavid , Julien Raft , Philippe Richebé

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引用次数: 0

摘要

研究目的评估深部神经肌肉阻滞对术中痛觉的影响在腹腔镜手术中，深部神经肌肉阻滞与中度神经肌肉阻滞相比，可改善手术条件和术后效果。但其对术中痛觉和阿片类药物需求的影响却从未被评估过：设计：单中心随机对照试验：患者我们纳入了 100 名 ASA I 到 III 级的结直肠腹腔镜手术患者，他们都接受了去氟烷-瑞芬太尼麻醉：患者被随机分为两组，通过重复注射罗库溴铵达到中度（1-3次四连反应）或深度（1-2次四连计数后）神经肌肉阻滞（NMB）。两组患者的术中瑞芬太尼给药均以痛觉水平（NOL）指数为指导：主要终点是术中每小时瑞芬太尼总用量。次要终点包括莱顿手术评分量表（L-SRS）、腹腔内压力、术后疼痛评分和阿片类药物消耗量：对 93 名患者进行了分析。主要结果：对 93 名患者进行了分析，其中深度组 45 人，中度组 48 人。深部 NMB 组术中瑞芬太尼用量为 348（228-472）μg.h-1，而中度 NMB 组为 494（392-618）μg.h-1：这项研究表明，在结直肠腹腔镜手术中，深层神经肌肉阻断可减少术中NOL引导下瑞芬太尼的用量，同时还能改善手术条件。试验注册：该研究已在 ClinicalTrials.gov 注册，注册号为 NCT03910998。

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Impact of deep neuromuscular blockade on intraoperative NOL-guided remifentanil requirement during desflurane anesthesia in laparoscopic colorectal surgeries: A randomised controlled trial

Study objective

Evaluate the impact of deep neuromuscular blockade on intraoperative nociception Deep neuromuscular blockade has been shown to improve surgical conditions and postoperative outcomes compared to moderate neuromuscular blockade in laparoscopic surgery. Still, its impact on intraoperative nociception and opioid requirement has never been assessed.

Design

Monocentric randomised controlled trial.

Setting

Operating room.

Patients

We included 100 ASA I to III patients who underwent colorectal laparoscopic surgery with desflurane-remifentanil anesthesia.

Interventions

Patients were randomised into two groups to achieve either moderate (1–3 train of four response) or deep (1–2 post-tetanic count) neuromuscular block (NMB) with repeated boluses of rocuronium. The Nociception Level (NOL) index guided intraoperative remifentanil administration in both groups.

Measurements

The primary endpoint was total intraoperative remifentanil administration per hour of surgery. Secondary endpoints included, Leiden Surgical Rating Scale (L-SRS), intra-abdominal pressure, postoperative pain scores and opioids' consumption.

Main results

Ninety-three patients were analysed. Forty-five in the deep group and 48 patients in moderate group. Intraoperative administration of remifentanil was 348 (228–472) μg.h⁻¹ in the deep NMB group compared to 494 (392–618) μg.h⁻¹ in the moderate NMB group (P < 0.001). Lowest L-SRS was 5 (4–5) in the deep NMB group versus 3 (2–5) (P < 0.001) in the moderate NMB group. Mean intra-abdominal pressure was 11.9 (1.3) in the deep NMB group versus 13 (1.3) (P < 0.001) in the moderate NMB group. Secondary postoperative outcomes including pain scores and analgesics administration were not significantly different.

Conclusions

This study shows that deep neuromuscular blockade reduces intraoperative NOL-guided administration of remifentanil in colorectal laparoscopic surgeries. It also improves surgical conditions.

Trial registration

The study was registered at ClinicalTrials.gov under NCT03910998.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.