Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis
| Autor: | C.J.H.M. van Laarhoven, Michiel C. Warlé, Andries E. Braat, Albert Dahan, E. V. van Helden, Gert Jan Scheffer, Moira H.D. Bruintjes |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Laparoscopic surgery
medicine.medical_specialty Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2] medicine.medical_treatment Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] laparoscopy artificial law.invention Abdominal wall 03 medical and health sciences Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] 0302 clinical medicine neuromuscular blockade Pneumoperitoneum Randomized controlled trial 030202 anesthesiology law medicine 030212 general & internal medicine Laparoscopy medicine.diagnostic_test business.industry medicine.disease Confidence interval Surgery Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia Meta-analysis pneumoperitoneum business Cohort study Abdominal surgery |
| Zdroj: | British Journal of Anaesthesia, 118(6), 834-842 British Journal of Anaesthesia, 118, 6, pp. 834-842 British Journal of Anaesthesia, 118, 834-842 |
| ISSN: | 0007-0912 |
| Popis: | Contains fulltext : 175538.pdf (Publisher’s version ) (Closed access) Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. We performed a systematic review and meta-analysis of studies comparing the influence of deep vs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes. Trials were identified from Medline, Embase, and Central databases from inception to December 2016. We included randomized trials, crossover studies, and cohort studies. Our search yielded 12 studies on the effect of deep NMB on the surgical space conditions. Deep NMB during laparoscopic surgeries improves the surgical space conditions when compared with moderate NMB, with a mean difference of 0.65 (95% confidence interval (CI): 0.47-0.83) on a scale of 1-5, and it facilitates the use of low-pressure pneumoperitoneum. Furthermore, deep NMB reduces postoperative pain scores in the postanaesthesia care unit, with a mean difference of - 0.52 (95% CI: -0.71 to - 0.32). Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit. Whether this leads to fewer intraoperative complications, an improved quality of recovery, or both after laparoscopic surgery should be pursued in future studies. The review methodology was specified in advance and registered at Prospero on July 27, 2016, registration number CRD42016042144. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|