*Macit YALÇIN, *Ayşe ÖZCAN, *Namık ÖZCAN, *Hülya BAŞAR, *Hatice Dilara
ÇOMAK, *Bülent BALTACI
Ankara Research and Training Hospital, Anaesthesiology and Reanimation Clinic,
Ankara, TURKEY
Background and Goal of Study:
Neuromuscular blockade improves surgical
space conditions in laparoscopic
cholecystectomy performed during
intraabdominal pressures lower than 12
mmHg. Adverse effects like abdominal pain,
nausea, vomiting are seen less during low
intraabdominal pressures. In the present study,
the effects of deep neuromuscular blockade
on surgical space conditions in laparoscopic
cholecystectomy performed during low
intraabdominal pressure were investigated.
Materials and Methods: After the approval
of the Instutional Review Board, sixty ASA
1-3 patients with BMI<35, aged 18-65 years
old, scheduled for laparoscopic
cholecystectomy were enrolled to the study.
Patients were randomized into deep (Group
D, n=20) and standart neuromuscular groups
(Group S, n=20) and control group (Group C,
n=20). Anaesthesia was induced with
propofol 2 mg/kg, fentanyl 1 µg/kg and
trachea was intubated after rocuronium 0,3
mg/kg in all patients. Inhalational anaesthetics
were used for maintenance of anaesthesia.
Neuromuscular monitoring was performed
using TOF-Watch SX acceleromyograph. In
group D additional rocuronium 0,3 mg/kg was
administered after intubation and 0,3-0,6 mg/
kg to maintain TOF 0, PTC<1. In Groups S
and C additional rocuronium 0,15 mg/kg was
administered if the surgical site was assessed
as poor by the surgeon or in case of 25%
recovery in TOF. The surgery was performed
at 14 mmHg intraabdominal pressure in
Group C, and at 8 mmHg in Groups S and D.
Four point scale and NRS (numeric rating
scale) were used to evaluate the surgical space
conditions. Pain and nausea-vomiting were
assessed postoperatively. Kruskal-Wallis test
was used for statistical analysis.
Results: ASA score, BMI, BIS, arterial blood
pressure and heart rate values were similar
between groups. Surgery was completed at 8
mmHg intraabdominal pressure in 18 and 5
patients in Groups D and S, respectively. This
difference was significant between Groups D
and S. There was no difference between
Groups C and D according to NRS and four
point scale scores. These scores were
significantly high in Group S compared to
Group D (p<0,05).
Discussion: Deep neuromuscular blockade
provides better surgical conditions in low
pressure laparoscopic cholecystectomy
operations compared to standard
neuromuscular blockade. Operations can be
performed during low intraabdominal
pressure by providing deep neuromuscular
blockade and the adverse effects of high
pressures can be prevented.
Assessment Of Effect Of Neuromuscular Blockade Level
On Surgical And Peroperative Conditions During Low
Pressure Laparoscopic Cholecystectomy
Staehr-Rye AK, Rasmussen LS, Rosenberg J, Juul P, Lindekaer AL, Riber C, Gätke MR. Surgical Space Conditions During Low-
Pressure Laparoscopic Cholecystectomy with Deep Versus Moderate Neuromuscular Blockade: A Randomized Clinical Study Anesth
Analg 2014; 119: 1084-92.

Assessment of effect of neuromuscular blockade level on surgical and peroperative conditions during low pressure laparoscopic cholecystectomy