The Effect of Deep Neuromuscular Blockade on Requirement of Intravenous Anesthetic Agent

Study Overview
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Brief Summary
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Recently, deep neuromuscular blockade during general anesthesia has been studied by many authors regarding various effects upon patients' outcomes and surgical conditions. We believe deep neuromuscular blockade can be especially beneficial in laparoscopic surgery, because it can expand surgical space and prevent patients' minute movements that can disturb precise operations. In clinical situations, anesthetists tend to compensate the insufficiency of neuromuscular blockade by increasing the dose of other anesthetic agents, which can prolong patients' recovery time and impair the surgical condition. In this study, we plan to divide the patients into 2 groups according to the depth of neuromuscular blockade, and compare the dose of anesthetic agent used to maintain surgical condition.

Detailed Description
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Patients undergoing elective laparoscopic colorectal surgery are going to be recruited and divided into 2 groups: Group D will receive deep neuromuscular blockade, and Group M will receive moderate neuromuscular blockade using continuous infusion of rocuronium. Acceleromyography(TOF-watch SX) will be used to monitor the depth of blockade. In both groups, the anesthesia will be maintained with TIVA(total intra-venous anesthesia) including continuous target-controlled infusion of propofol and remifentanil. During the surgery, the number of patient movement and restoration of self respiration will be recorded. At the end of anesthesia, the dose of propofol and remifentanil used will be assessed and compared between the groups. Also, the satisfaction score of surgeons regarding the surgical condition, the anesthesia time, the operation time will be documented. After the patients are discharged, their charts are going to be reviewed and whether any pulmonary or surgical complications occurred will be documented.

Official Title
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The Effect of Deep Neuromuscular Blockade on Requirement of Intravenous Anesthetic Agent During Laparoscopic Colorectal Surgery

Conditions
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Laparoscopy, General Anesthesia, Neuromuscular Blockade

Intervention / Treatment
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* Drug: Rocuronium: PTC(Post-tetanic count) 1 2
* Drug: Rocuronium: TOF(Train-of-four) 1 2


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing elective laparoscopic colorectal resection due to benign or malignant neoplasm of colon or rectum ASA class I or II Exclusion Criteria: Patients receiving medications known to have drug-drug interaction with neuromuscular blocking agents Patients who have significantly impaired cardiac, pulmonary, hepatic, renal function Patients who are pregnant Patients who are known to have hypersensitivity to the anesthetic/analgesic/neuromuscular blocking agents which are going to be used in the study BMI < 18.5 or > 35.0 kg/m2 Patients with previous history of open abdominal surgery Patients with previous history of malignant hyperthermia

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group D<br>Deep neuromuscular blockade | Drug: Rocuronium: PTC(Post-tetanic count) 1 2<br>* Deep neuromuscular blockade will be maintained using continuous infusion of rocuronium.<br>* Other names: Deep block;|
| Active Comparator: Group M<br>Moderate neuromuscular blockade | Drug: Rocuronium: TOF(Train-of-four) 1 2<br>* Moderate neuromuscular blockade will be maintained using continuous infusion of rocuronium.<br>* Other names: Moderate block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dosage of propofol | the amount of propofol used (mg/kg) | intraoperative (from starting of anesthesia to end of anesthesia) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dosage of remifentanil | the amount of remifentanil used (mcg/kg) | intraoperative (from starting of anesthesia to end of anesthesia) | 
| Patient movement | the observed number of patient movement during the surgery | intraoperative (from tracheal intubation to injection of neuromuscular reversal agent) | 
| Patient self respiration | the observed number of restoration of self breathing during the surgery (ex. EtCO2 notching) | intraoperative (from tracheal intubation to injection of neuromuscular reversal agent) | 
| Surgical condition score | the 5-point satisfaction score of surgeon regarding surgical conditions | assessed at the end of the surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Deep neuromuscular blockade