The Comparison Of Moderate And Deep Neuromuscular Block Induced By Continuous Infusion Of Cisatracurium In Patients With Laparoscopic Surgery

Objective:The present study was conducted to investigate the feasibility of moderate neuromuscular blockade (defined as train of four stimulation of 1-2) and deep neuromuscular blockade (defined as post-tetanic count of 1-2) induced by continuous infusion of cisatracurium, to compare the different impacts of neuromuscular blockade on surgical condition and postoperative recovery quality between moderate and deep neuromuscular blockade, and to define the optimized degree of neuromuscular blockade during laparoscopic gynecological surgery.Methods:65 patients scheduled for non-emergency laparoscopic gynecological surgery were randomly allocated into moderate neuromuscular blockade group (Group T, n=32) and deep neuromuscular blockade group (Group P, n=33). In all subjects, two-fold ED95 bolus of cisatracurium was administered to facilitate tracheal intubation, followed by continuous infusion. Intraoperatively, continuous infusion rate was adjusted to achieve train of four stimulation of 1-2 in Group T and post-tetanic count of 1-2 in Group P. Different impacts of neuromuscular blockade on surgical condition and postoperative recovery quality between moderate and deep neuromuscular blockade were evaluated.Results:5 patients were excluded because laparoscopic procedure was converted to open surgery or surgery exceeded 4 hours, and consequently 30 patients were analysed in either group. Both of the groups achieved precise and stable neuromuscular blockade as required. The mean infusion rate of cisatracurium was significantly slower in Group T (1.12±0.26μg·kg-1·min-1) than in Group P (1.83±0.54μg·kg-1·min-1) (P<0.05). The intra-abdominal pressure was lower in Group P than in Group T, but it did not lead to significant differences in surgery time and surgical rating scale within the two groups (P >0.05). The recovery time of neuromuscular blockade evaluated by TOF and the extubation time was longer in group P than in group T (P< 0.05).Conclusion:Continuous infusion of cisatracurium was able to maintain both deep neuromuscular blockade and moderate neuromuscular blockade. Compared to moderate neuromuscular blockade, deep neuromuscular blockade was associated with increased infusion rate and prolonged recovery, but not improved surgical condition for laparoscopic procedure. Consequently, moderate neuromuscular blockade was recommended for laparoscopic surgery.