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Journal of Clinical Anesthesia and Pain Medicine

JCAPM

Aabstract

Research Article

Deep Neuromuscular Blockade versus Remifentanil or Sevoflurane to Augment Measurable Laparoscopic Workspace during Bariatric Surgery Analysed by a Randomised Controlled Trial

Jan P. Mulier, Bruno Dillemans

Correspondence Address :

Jan P. Mulier
Department of Anaesthesiology
AZ Sint Jan Brugge-Oostende
Belgium
Email: jan.mulier@azsintjan.be / janpaul.mulier@gmail.com

Received on: January 22, 2018, Accepted on: January 30, 2018, Published on: February 06, 2018

Citation: Jan P. Mulier, Bruno Dillemans (2018). Deep Neuromuscular Blockade versus Remifentanil or Sevoflurane to Augment Measurable Laparoscopic Workspace during Bariatric Surgery Analysed by a Randomised Controlled Trial

Copyright: 2018 Jan P. Mulier, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract

Abstract
Surgeons are often challenged by a limited laparoscopic workspace, especially in patients with morbid obesity.
The main objective was to measure whether anaesthetics, deep neuromuscular blockade (NMB), or high-dose opioids contribute to improving the laparoscopic workspace.
Patients were randomised between three study groups, blinded for the patients and the surgeon.
AZ Sint Jan Brugge-Oostende, campus Brugge, Bruges, Belgium, from 15 may 2013 till 15 December 2014.
A total of 50 patients undergoing elective laparoscopic bariatric surgery. Reasons for non-inclusion: Males with central morbid obesity and patients with previous laparotomy, known allergy to one of the drugs used.
We objectively gauged the laparoscopic workspace using abdominal compliance and pressure at zero volume (PV0) calculated from a 3-point measurement of the abdominal pressure-volume relationship (APVR). Anaesthesia was induced and maintained with total intravenous anaesthetics without opioids or neuromuscular blockers. APVR was measured before and after administering either remifentanyl, 2 μg/kg (Group A); sevoflurane, 2% endtidal concentration (Group B); or rocuronium, 1 mg/kg (Group C). A surgeon was asked to grade the surgical workspace and movement conditions, the workspace was objectively measured, and these values were compared.
Only rocuronium reduced PV0 and increased laparoscopic workspace measured by APVR. All patients receiving sevoflurane needed improvements in the surgical conditions. Patients receiving rocuronium had the best surgical conditions.

An insufflation volume of 3 litres appears to be optimal for bariatric surgery at our centre. However, this target was not feasible in all patients at a stipulated pressure of 15 mmHg. Rocuronium combined with a patient adapted abdominal pressure may increase the likelihood of obtaining the optimal workspace.
Trial registration: Clinicaltrials.gov identifier: NCT01930747

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