The Benefits of Deep Neuromuscular Block and Sugammadex in Laparoscopic Colorectal Surgery
Status:
Completed
Trial end date:
2015-09-01
Target enrollment:
Participant gender:
Summary
Pneumoperitoneum, the use of carbon dioxide, presents some disadvantages, including a risk of
hypercarbia and respiratory acidosis during surgery in the respiratory system, and of an
increased mean arterial pressure and systemic vascular resistance due to sympathetic
excitation in the cardiovascular system. 10~15 mmHg intra-abdominal pressure is required in
order to achieve a pneumoperitoneum, and increased abdominal pressure following a
pneumoperitoneum causes hemodynamic changes leading to a reduced cardiac function by
increasing the left ventricular end systolic wall stress and the right and left ventricular
filling pressure, while decreasing the stroke volume and cardiac index. The author compared
the intra-abdominal pressure necessary to achieve a pneumoperitoneum under deep muscle
relaxation and medium muscle relaxation in ten patients undergoing laparoscopic surgery for
colorectal cancer as part of preliminary research. The results showed that deep muscle
relaxation, compared to medium muscle relaxation, was able to lower the intra-abdominal
pressure by an average of 5.6 mmHg (13.2 ± 0.8 vs 7.6 ± 1.1) and the inspiratory pressure by
an average of 8. Above all, even after lowering the intra-abdominal pressure with deep muscle
relaxation, the surgeon was able to maintain a view almost identical to the one afforded by
medium muscle relaxation. However, up until now, no reports have clearly indicated the change
in pneumoperitoneum pressure, the patient's hemodynamic change, post-operative recovery, and
surgical prognosis depending on the depth of muscle relaxation.Against this background, this
study aims to identify the degree to which intra-abdominal pressure in laparoscopic
colorectal surgery can be reduced by deep muscle relaxation, and the corresponding advantages
this method presents in terms of physiological changes such as hemodynamic and respiratory
system changes. In addition, the study intends to examine the difference between deep muscle
relaxation and medium muscle relaxation in terms of surgical prognosis, including their
effects on post-operative pain and on the patient's recovery of intestinal mobility.