Automated Quantitative Relaxometry for Deep Neuromuscular Blockade in Robot-Assisted Prostatectomy
et | 10 août 2020
Article Category: Research Article
Publié en ligne: 10 août 2020
Pages: 29 - 34
DOI: https://doi.org/10.2478/rjaic-2020-0004
Mots clés
© 2020 Michèle Sunnen et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Purpose
During pneumoperitoneum (PP) for robot-assisted prostatectomy, a deep neuromuscular block (NMB) is necessary. New relaxometry equipment permits maintenance of profound NMB in order to improve patient safety and surgical conditions.
Methods
Twenty adult patients undergoing robot-assisted prostatectomy were included. Under automated quantitative relaxometry with the TOFcuffTM device, rocuronium dosing was adapted with the aim to keep NMB at deep levels. The time fractions with intense block (PTC 0), adequately deep block (PTC 1 to 3) and a not sufficiently deep block (PTC > 3) were quantified.
Results
An optimally deep block (PTC 1–3) was achieved during 110 ± 38 min (50 ± 15%). Intense block was found during 60 ± 45 min (27 ± 18%) of total PP time. Values of PTC > 3 lasted 60 ± 45 min (23 ± 17%). Median PTC always remained between 1 and 3. Inadvertent movements during PP were never encountered, and operation conditions as reported by the surgeons were excellent.
Conclusion
Our technique of controlled profound NMB by repetitive bolus doses achieved its goal in 77% of PP time. Under automated quantitative relaxometry, an optimized rocuronium dosing strategy should be applied to maintain a high level of safety and adequate operation conditions without risking an unnecessary prolongation of NMB into the post-pneumoperitoneum period.