Author/Authors :
Garneau Pierre Y. نويسنده Department of Surgery, Division of Bariatric Surgery,
Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin O., Montreal,
QC, H4J 1C5, Canada , Garofalo Fabio نويسنده Department of Surgery, Division of Bariatric Surgery,
Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin O., Montreal,
QC, H4J 1C5, Canada , Deslauriers Valerie نويسنده Department of Surgery, Division of Bariatric Surgery,
Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin O., Montreal,
QC, H4J 1C5, Canada , Bacon Simon L. نويسنده Centre de Medecine Comportementale de Montreal, Hopital du
Sacre-Cœur, Montreal, University of Montreal, Montreal, Quebec,
Canada , Denis Ronald نويسنده Department of Surgery, Division of Bariatric Surgery,
Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin O., Montreal,
QC, H4J 1C5, Canada , Pescarus Radu نويسنده Department of Surgery, Division of Bariatric Surgery,
Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin O., Montreal,
QC, H4J 1C5, Canada , Atlas Henri نويسنده Department of Surgery, Division of Bariatric Surgery,
Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin O., Montreal,
QC, H4J 1C5, Canada , Delisle Marc نويسنده Rockland MD Surgical Centre, Montreal, Quebec,
Canada , Tremblay Isabelle نويسنده Anesthesia Department, Hopital du Sacre-Coeur de Montreal,
5400 boul Gouin O., Montreal, QC, H4J 1C5, Canada
Abstract :
Background To date, little is known about neuromuscular blockade
(NMB) and its impact in bariatric surgery and patient recovery. The goal
of this study was to better assess the relationship between depth of
NMB, bariatric surgeon’s satisfaction, and the quality of patient
recovery. Methods Between January and September 2015, we did a
prospective observational study of 50 morbidly obese patients undergoing
elective laparoscopic sleeve gastrectomy (LSG) under general anesthesia
at our ambulatory surgical center. Rocuronium was used for tracheal
intubation with bolus doses to maintain NMB. NMB was monitored at 5
minute intervals during the surgery, and at 30 second intervals
following the reversal agent. The surgeon was blind to all anesthesia
procedures and scored the surgical working conditions at 15 min
intervals. Demographic data, operative data, and conditions were
analyzed. Results 42 females and 8 males, with a mean age of 38.8 years
(range: 19 to 60, standard deviation (SD): ± 9.2), and mean BMI of 43.9
(range: 36 to 58, SD: ± 5.1), underwent a LSG. Mean total surgical time
was 63 minutes (range: 35 to 128). During the laparoscopic part of the
surgery, 22% of the patients were in deep block and 78% were in moderate
block. Six patients presented “poor” or “extremely poor” surgical
conditions, and 6 patients had a sudden increase in intra-abdominal
pressure. None of these patients were in deep block at that time.
Patients in deep NMB had a shorter laparoscopic time (37 minutes, SD ±
7.1 vs 53 minutes, SD ± 18.3; P = 0.006). Conclusions This study found
that deep NMB prevents inappropriate abdominal cavity movement,
consequently improving the operating area and the surgeon satisfaction.
