The Benefits of Deep Neuromuscular Block and Sugammadex in Laparoscopic Colorectal Surgery
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      Pneumoperitoneum, the use of carbon dioxide, presents some disadvantages, including a risk of
      hypercarbia and respiratory acidosis during surgery in the respiratory system, and of an
      increased mean arterial pressure and systemic vascular resistance due to sympathetic
      excitation in the cardiovascular system. 10~15 mmHg intra-abdominal pressure is required in
      order to achieve a pneumoperitoneum, and increased abdominal pressure following a
      pneumoperitoneum causes hemodynamic changes leading to a reduced cardiac function by
      increasing the left ventricular end systolic wall stress and the right and left ventricular
      filling pressure, while decreasing the stroke volume and cardiac index. The author compared
      the intra-abdominal pressure necessary to achieve a pneumoperitoneum under deep muscle
      relaxation and medium muscle relaxation in ten patients undergoing laparoscopic surgery for
      colorectal cancer as part of preliminary research. The results showed that deep muscle
      relaxation, compared to medium muscle relaxation, was able to lower the intra-abdominal
      pressure by an average of 5.6 mmHg (13.2 ± 0.8 vs 7.6 ± 1.1) and the inspiratory pressure by
      an average of 8. Above all, even after lowering the intra-abdominal pressure with deep muscle
      relaxation, the surgeon was able to maintain a view almost identical to the one afforded by
      medium muscle relaxation. However, up until now, no reports have clearly indicated the change
      in pneumoperitoneum pressure, the patient's hemodynamic change, post-operative recovery, and
      surgical prognosis depending on the depth of muscle relaxation.Against this background, this
      study aims to identify the degree to which intra-abdominal pressure in laparoscopic
      colorectal surgery can be reduced by deep muscle relaxation, and the corresponding advantages
      this method presents in terms of physiological changes such as hemodynamic and respiratory
      system changes. In addition, the study intends to examine the difference between deep muscle
      relaxation and medium muscle relaxation in terms of surgical prognosis, including their
      effects on post-operative pain and on the patient's recovery of intestinal mobility.
    


Intervention name(s): Deep neuromuscular block using rocuronium and reversal with suggamadex; Moderate neuromuscular block using rocuronium and reversal with suggamadex
Intervention type(s): Drug; Drug
Intervention description(s): Deep neuromuscular block and moderate neuromuscular block with Esmerone and reversal with bridion; Moderate neuromuscular block and moderate neuromuscular block with Esmerone and reversal with bridion
Intervention MeSH terms: Rocuronium
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Keywords: deep neuromuscular block; sugammadex; laparoscopic colorectal surgery; hemodynamic change