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Korean J Anesthesiol. 2014 Jul;67(1):20-5. doi: 10.4097/kjae.2014.67.1.20. Epub 2014 Jul 29.

Effect of pneumoperitoneum on the recovery from intense neuromuscular blockade by rocuronium in healthy patients undergoing laparoscopic surgery.

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1
Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science, Incheon, Korea.

Abstract

BACKGROUND:

This study investigated the effect of pneumoperitoneum on the recovery from intense neuromuscular blockade by rocuronium in healthy patients undergoing laparoscopic abdominal surgery.

METHODS:

Thirty adult patients undergoing laparoscopic abdominal surgery were studied. Anesthesia was induced with 1.5 mg/kg of propofol, 12 ug/kg of alfentanil and 0.6 mg/kg of rocuronium and maintained with 2 vol% of sevoflurane and 0.05-0.2 µg/kg/min remifentanil. The neuromuscular relaxation was monitored by Train-of-Four (TOF) and post-tetanic count (PTC). Additional rocuronium of 0.2 mg/kg was administered for deep neuromuscular blockade at 30 min after pneumoperitoneum. Before (PPpre) and 30 min after pneumoperitoneum (PPpost), PTC was measured at 6 min intervals. The relationship between PTC and the time interval to reappearance of T1 response was observed.

RESULTS:

The mean ± SD of the intervals between the detection of 4 counts of the PTC and the first response to TOF stimulation was 13.0 ± 1.1 min and 16.4 ± 6.3 min PPpre and PPpost, respectively (P = 0.20). There were significant negative relationships between PTC observed and the time interval to reappearance of T1 response (adjusted R(2) = 0.869, P < 0.001 for PPpre data, and adjusted R(2) = 0.561, P < 0.001 for PPpost data). Comparing the difference of regression equation between PPpre and PPpost data using a parallelism test, there was no statistically significant difference (P = 0.193).

CONCLUSIONS:

This study showed that PP with intra-abdominal pressure at the level of 13-14 mmHg did not affect the recovery from intense neuromuscular blockade by rocuronium in healthy patients undergoing laparoscopic abdominal surgery.

KEYWORDS:

Neuromuscular blockade; Neuromuscular monitoring; Pneumoperitoneum; Rocuronium

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