Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Harvard

APA

CBE

MLA

Vancouver

Author

Bibtex

@article{50122fa5f29049438580b2bad4509221,
title = "Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study",
abstract = "BACKGROUND: Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions.OBJECTIVES: The current study investigated if deep compared with no NMB improved the surgical view during laparoscopic ventral hernia repair.DESIGN: Crossover study.SETTING: The study was carried out at Herlev and Gentofte Hospital, University of Copenhagen, Denmark and conducted from May 2015 until February 2017.PARTICIPANTS: A total of 34 patients were randomised in an investigator-initiated, assessor-blinded crossover design of deep vs. no NMB during laparoscopic ventral hernia repair.INCLUSION CRITERIA: Adults scheduled for elective laparoscopic ventral hernia repair.EXCLUSION CRITERIA: Known allergy to any study medication, known homozygous variants in the butyrylcholinesterase gene, severe renal disease, neuromuscular disease, lactating or pregnant women, any indication for rapid sequence induction.INTERVENTIONS: Deep NMB was established with rocuronium and reversed with sugammadex. Anaesthesia was conducted with propofol and remifentanil.MAIN OUTCOME MEASURES: The primary outcome was evaluation of surgical view assessed on a five-point rating scale. Other outcomes included the surgical conditions during laparoscopic suturing of the hernia defect.RESULTS: We found no difference in ratings for the surgical view when comparing deep with no NMB: mean -0.1 (95{\%} confidence interval -0.4 to 0.2) (P = 0.521, paired t test). However, deep compared with no NMB improved the rating score for surgical conditions while suturing the hernia defect (P = 0.012, Mann-Whitney U test). No differences were found in either total length of surgery (P = 0.76) or hernia suturing time (P = 0.81).CONCLUSION: Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02247466.",
author = "S{\"o}derstr{\"o}m, {Carl M} and S{\o}ren F{\o}lsgaard and Jacob Rosenberg and G{\"a}tke, {Mona R} and Madsen, {Matias V} and Sami Assadzadeh and Medici, {Roar Borregaard}",
year = "2018",
month = "11",
doi = "10.1097/EJA.0000000000000833",
language = "English",
volume = "35",
pages = "876--882",
journal = "European Journal of Anaesthesiology",
issn = "0265-0215",
publisher = "Lippincott Williams & Wilkins",
number = "11",

}

RIS

TY - JOUR

T1 - Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair

T2 - A randomised, blinded study

AU - Söderström, Carl M

AU - Følsgaard, Søren

AU - Rosenberg, Jacob

AU - Gätke, Mona R

AU - Madsen, Matias V

AU - Assadzadeh, Sami

AU - Medici, Roar Borregaard

PY - 2018/11

Y1 - 2018/11

N2 - BACKGROUND: Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions.OBJECTIVES: The current study investigated if deep compared with no NMB improved the surgical view during laparoscopic ventral hernia repair.DESIGN: Crossover study.SETTING: The study was carried out at Herlev and Gentofte Hospital, University of Copenhagen, Denmark and conducted from May 2015 until February 2017.PARTICIPANTS: A total of 34 patients were randomised in an investigator-initiated, assessor-blinded crossover design of deep vs. no NMB during laparoscopic ventral hernia repair.INCLUSION CRITERIA: Adults scheduled for elective laparoscopic ventral hernia repair.EXCLUSION CRITERIA: Known allergy to any study medication, known homozygous variants in the butyrylcholinesterase gene, severe renal disease, neuromuscular disease, lactating or pregnant women, any indication for rapid sequence induction.INTERVENTIONS: Deep NMB was established with rocuronium and reversed with sugammadex. Anaesthesia was conducted with propofol and remifentanil.MAIN OUTCOME MEASURES: The primary outcome was evaluation of surgical view assessed on a five-point rating scale. Other outcomes included the surgical conditions during laparoscopic suturing of the hernia defect.RESULTS: We found no difference in ratings for the surgical view when comparing deep with no NMB: mean -0.1 (95% confidence interval -0.4 to 0.2) (P = 0.521, paired t test). However, deep compared with no NMB improved the rating score for surgical conditions while suturing the hernia defect (P = 0.012, Mann-Whitney U test). No differences were found in either total length of surgery (P = 0.76) or hernia suturing time (P = 0.81).CONCLUSION: Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02247466.

AB - BACKGROUND: Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions.OBJECTIVES: The current study investigated if deep compared with no NMB improved the surgical view during laparoscopic ventral hernia repair.DESIGN: Crossover study.SETTING: The study was carried out at Herlev and Gentofte Hospital, University of Copenhagen, Denmark and conducted from May 2015 until February 2017.PARTICIPANTS: A total of 34 patients were randomised in an investigator-initiated, assessor-blinded crossover design of deep vs. no NMB during laparoscopic ventral hernia repair.INCLUSION CRITERIA: Adults scheduled for elective laparoscopic ventral hernia repair.EXCLUSION CRITERIA: Known allergy to any study medication, known homozygous variants in the butyrylcholinesterase gene, severe renal disease, neuromuscular disease, lactating or pregnant women, any indication for rapid sequence induction.INTERVENTIONS: Deep NMB was established with rocuronium and reversed with sugammadex. Anaesthesia was conducted with propofol and remifentanil.MAIN OUTCOME MEASURES: The primary outcome was evaluation of surgical view assessed on a five-point rating scale. Other outcomes included the surgical conditions during laparoscopic suturing of the hernia defect.RESULTS: We found no difference in ratings for the surgical view when comparing deep with no NMB: mean -0.1 (95% confidence interval -0.4 to 0.2) (P = 0.521, paired t test). However, deep compared with no NMB improved the rating score for surgical conditions while suturing the hernia defect (P = 0.012, Mann-Whitney U test). No differences were found in either total length of surgery (P = 0.76) or hernia suturing time (P = 0.81).CONCLUSION: Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02247466.

U2 - 10.1097/EJA.0000000000000833

DO - 10.1097/EJA.0000000000000833

M3 - Journal article

VL - 35

SP - 876

EP - 882

JO - European Journal of Anaesthesiology

JF - European Journal of Anaesthesiology

SN - 0265-0215

IS - 11

ER -

ID: 56441760