Effects Of Different Pneumoperitoneum Pressures Combined With Different Neuromuscular Block Depths On Postoperative Renal Function In Elderly Patients Undergoing RARP

Background: With the development of high-tech medicine,the number of operations for robot-assisted radical prostatectomy(RARP)is also increasing,the population distribution of the operation is mostly elderly patients,and it’s necessary to establish a long period of high-pressure pneumoperitoneum and maintain a steep Trendelenburg position.Previous studies have focused on whether DMB combined with LPP have an impact on surgical conditions,cardiopulmonary function,postoperative pain and postoperative recovery quality.There have been few studies on the effects of perioperative renal function in patients.Our aim is to find the most appropriate degree of neuromuscular block and pneumoperitoneum pressure to meet the requirements of surgeons for good surgical conditions and sufficient surgical vision,and reduce perioperative complications,achieve perioperative organ protection,and promote ERAS in patients.Methods:72 elderly patients undergoing RAPP surgery were included and randomly divided into 3 groups with 24 cases in each group: group I was SPP+DMB group;group II was SPP+MMB group;group III was LPP+DMB group.Group I was SPP+DMB group;Group II was SPP+MMB group;Group III was LPP+DMB group.All three groups were induced using rocuronium bromide(0.6 mg/kg): the MMB group maintained 1-2 responses to Train-of-Four stimulation(TOF)(measured every 5min);DMB group maintained 1-2 responses to Post-Tetanic Count Stimulation(PTC)(measured every 5min).The pneumoperitoneum pressure was 15 ± 1mm Hg in the SPP group and 8 ± 1mm Hg in the LPP group.The main outcome was NGAL levels before surgery(T1),immediate after surgery(T2)and 1 day after surgery(T3).The secondary outcomes were Ccr,CREA,and BUN levels at T1,T2,and T3,and the incidence of AKI,the incidence of intestinal obstruction.Measurement data were expressed as mean ± standard deviation(χ2 ± s),using analysis of variance;discrete data were expressed as median(interquartile range IQR),using generalized estimating equation analysis;enumeration data were expressed as cases(percentage),using χ2 test.The difference was considered to be statistically significant at P<0.05.Results: 21 patients were included in each of the three groups.Compared with the baseline levels before surgery(T1),the levels of NGAL,Ccr,CREA,and BUN in the three groups on the 1st day after surgery(T3)were increased,and the difference was statistically significant(P<0.05).In the comparison between groups of NGAL levels 1 day after operation(T3),group II had the most significant increase,group I was in the middle,and group III had the lowest level,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of AKI and intestinal obstruction(P>0.05).Conclusion: The anesthesia of standard pneumo-abdominal pressure combined with moderate neuromuscular block had the greatest effect on perioperative renal function in elderly patients undergoing laparoscopic surgery,while anesthesia with low pneumoperital pressure combined with deep neuromuscular block had the least effect on renal function which can contribute to perioperative renal protection in elderly patients.