Comparising The Effection Of Closed-loop Or Continuous Injection Of Vecuronium Bromide During Laparoscopic Cholecystectomy

Objective:This study aim to compare the difference of neuromuscular blockade effect,neuromuscular blockade recovery,residuale neuromuscular block and postoper-rative shoulder pain between closed-loop or intermittent injecetion of vecuronium.Methods:From November 2018 to February 2019,sixtiy patients who were selected for laparascopic cholecystectomy in Fourth Affiliated Hospial of Kunming Medical University were collected into this study.All of these patients whose ages were in the rang from 18 to 60 years old.Their ASA grade were from I to II.None of them had a contrindication of vecuronium bromide.Their BMI were withen the range from 18.5 to 29.9 kg/m2.These 60 patients were randomly divided into two different groups,one group is the vecuronium bromide closed-loop injection group(group E)and the other group is the vecuronium continuous injection group(group C).Patients in both groups were induced by intravenous injection of midazolam 0.04mg/kg,sufentanil0.4ug/kg,etomidate 0.4mg/kg,injection of vecuromium bromide differ to the groups,mechanical ventilation was poformed after intubation,and ramained the PETCO2 between 27mmHg to 32mmHg.Total intravenous anesthesia was used duiring operation.During the operation,intra-abdominal pressure was maintained at 10 mmHg.In group E,the effect of muscle relaxation was induce and maintained by the cloosed-loop muscle relaxation injection system.The parameters were set as follows:the induced dose was 0.1 mg/kg,the dosage codition was when the TOF count was 1,the dosage speed was 1 mg·kg-1·h-1,and the maintenance speed was 0.01 mg·kg-1·h-1.In group C,vecuronium bromide was intravenously injected at the dose of 0.1 mg/kg during induction.According to the experence of anesthesiologists and the pharmacokinetics of vecuromium bromid,third of the induced dose of vecuronium was intravenously injected per 30 to 40 minutes.The remedial measure:when the intraoperative surgon complained about the musle relaxion and the TOF count were more than 1,a dose of 0.02mg/kg of vecuronium bromide was added.When the gallbladder was completely dissociated into the abdominal cavity,the anesthesiologists stop the use of vecuronium bromide..Stop pumping propofol and remifentanil at the end of sutures.In order to observe the spontaneous recovery of muscle relaxation,antagonistic drugs were not used routinely after sugery.If the TOFr was still less than 0.75 when it was more than 1 hour after surgery,neostigmine and atropine were injected.When the patients reached the extubation condition,the endotracheal tubes would be removed.After extubation,the patients were observed for residual adverse events of muscle relaxation,such as decreased oxygen saturation,cough weakness and so on.When the patient reched the PACU transfer conditions,they could be sent back to the wards.The intubation time(ti:from the beginning of injection of vecuromium to the finishment of intubation),muscle relaxants used time(t2:the time of pumping vecuronium in group E;the time from the fist injection of vecuromium to the final addition of vecuromium in group C),surgery time(t3:the time between the incision of navel skin and the suture of the last incision),the times of TOFr remove to different ranges(t4 to t7),the extubation time(ts:from the end of using vecuromium to extubation),and the PACU time(t9:the time staying in the PACU after extubation)were recorded.TOF counts and TOFr at five time points(at the intubation,operation initiation,gallbladder dissected,gallbladder extraction and abominal closuer)were recorded.Cooper scores of the patiants and the number of secondary intubation cases in two groups were recorded during intubation.And the number of complaints about muscle relaxation by the surgeon during the operation was recorded.The total amount and the average maintenance dose of vecuronium bromide were recorded.Recorded the number of cases who needed muscle relaxant antagonist.The number of patients who survived in adverse events of residuale neuromuscular block or postoperative shoulder pain were observed and recorded.Results:(1)There was no significant difference in general informations,such as the gender,age,ASA grades,BMI,muscle relaxants used time(t3)and operation time(t3)between two groups(p>0.05).(2)There was no significant difference in the total amout of vecuronium bromide between the two groups(p>0.05),while the average maintenance dose of vecuronium bromide in group E was significantly higher than that in group C(p<0.05).(3)The intubation time in group E was significantly longer than that in group C,while the Copper score was also significantly higher than that in group C,with statistically significant differences(p<0.05).During intubation,TOF counts and TOFr of the patients in group C were higher than that in group E,and the difference was statistically significant(p<0.05).All patients in group E were intubated successfully for once,while 3 patients in group C requiered secondary intubation due to choking or cough,but there was no significant difference in percentage of secondary intubation between the two groups(p>0.05).(4)The number of complaints of surgeons in group E was significantly lower than that in group C(p<0.05).When gallbladder was dissected(T3),TOF counts of patients in group E were lower than those in group C(p<0.05),but the diference in TOFr of patients between the two groups was no statistically signifcant(p>0.05).At the time points of T2,T4 and T5,there were no statistically significant differences in TOF counts and TOFr between two groups(p>0.05).(5)Comparing the recovery indexes of muscle relaxation:the times of TOFr recovering to 0.25,0.5,0.75,0.9,the extubation time and ventricular exit time had no significant difference between the two groups(p>0.05).(6)Comparing the percentage of patients who need muscle relaxant antagonist and incidences of muscle relaxant adverse everts,shows no statistical significant differences(p>0.05).The incidence of postoperative shoulder pain in group E was lower than that in group C,and the difference was statistically significant(p<0.05).Conclusions:During Laparoscopic Cholecystectomy,compaerde to the traditional intermittent intravenous injection of vecuronium bromide,the injection of vecuromium bromide with closed-loop muscle relaxant injection system has these benefits:(1)It helps to judge the accurate time of intubation and improves the safty of induction in genaral anesthesia.(2)It can provied more satisfactory intraoperative muscle relaxant maintenance effct during laparoscopic cholecystectomy.And it has no effect on the recovery of muscle relaxation after operation.The incedence of muscle relaxant adverse everts has not increased when the closed-loop muscle relaxant injection system was used.