Background and Goal of Study: Work space during laparoscopic surgery can be affected by several factors1,2. The aim of the study was to compare the effect of two different levels of neuromuscular blockade on the abdominal compliance (work space) during the pneumoperitoneum.
Materials and Methods: 28 women ASA 1-2, 42±14 years old and normalrange BMI scheduled for laparoscopic surgery were included in the study after the evaluation by the hospital review board. 18 women had previous abdominal surgery and/or pregnancy (GROUP A) while 10 women did not have neither previous abdominal surgery nor pregnancy (GROUP B).
Anesthesia was induced and mainteined with propofol and remifentanyl infusions. Rocuronium was used for neuromuscular block (NMB) and monitoring of NMB was assessed with TOF-WATCH accelerometer.
Volume-pressure relationship was measured 2 times during pneumoperitoneum establishment before surgery, one time at clinical NMB (1-3 TOF responses) and one time at profound NMB (0 TOF responses, 1-3 post-tetanic count). All CO2 introduced with Verres needle was allowed to escape after the insertion of the abdominal trocar. During insufflation through the trocar at a flow of 1,5L/min the abdominal pressure was measured at 1,2,3, and 4L of insufflation at clinical NMB. After this first measurement, all CO2 was allowed to escape and a new measurement was done when profound NMB was established. Volume-pressure data were fit by a linear least-square regression to calculate the compliance and a paired t test was used for comparison.
Results and Discussion: Abdominal compliance was increased in a non significant manner when profound NMB was established, both when the 28 patients were considered together (0,29±0,15 vs 0,31±0,15 L/mmHg, p=0,16) both when the 2 GROUPS were analyzed separately (GOUP A 0,33±0,16 vs 0,35±0,17 L/mmHg, p=0,21; GROUP B 0,22±0,07 vs 0,23±0,08 L/mmHg;p=0,56). GROUP A had a significant greater abdominal compliance than GROUP B at the 2 levels of NMB.
Conclusion(s): The study shows that profound NMB does not improve significantly abdominal compliance during laparoscopic surgery in comparison with clinical NMB. Women with previous abdominal surgery and/or pregnancy showed higher abdominal compliance that women without previous surgery/pregnancy did.
1. Mulier JP, Dillemans B, Van Cuwenberge S. Surg Endosc 2010;24:1398-403.
2. Mulier JP, García M, Dillemans B. Acta Anaesth Belg 2009;60:149-53.