Top

World Journal of Urology

Published in:

01-02-2019 | Original Article

Comparison between the effects of deep and moderate neuromuscular blockade during transurethral resection of bladder tumor on endoscopic surgical condition and recovery profile: a prospective, randomized, and controlled trial

Authors: C. H. Koo, S. H. Chung, B. G. Kim, B. H. Min, S. C. Lee, A. Y. Oh, Y. T. Jeon, J. H. Ryu

Published in: World Journal of Urology | Issue 2/2019

Abstract

Purpose

To compare between deep neuromuscular blockade (NMB) and moderate NMB with respect to endoscopic surgical conditions and recovery profiles in patients with general anesthesia for transurethral resection of bladder (TURB).

Methods

108 patients undergoing elective TURB were randomized into two groups: the moderate NMB (n = 54) or deep NMB (n = 54) group. After the operation, NMB was reversed with 2 mg/kg sugammadex at a train-of-four (TOF) count of 1 or 2 (moderate NMB group) or with 4 mg/kg sugammadex at post-tetanic count (PTC) of 2 (deep NMB group). Surgeons, who were blinded to the study design, rated the endoscopic surgical condition on a 5-point scale (1 = extremely poor, 2 = poor, 3 = acceptable, 4 = good, 5 = optimal) immediately following the operation. Recovery profiles, including postoperative residual curarization (PORC), respiratory complication, and recovery time, were recorded.

Results

No difference was observed between the two groups regarding patients and anesthesia characteristics. There were statistically significant differences in endoscopic surgical conditions between the two groups (P < 0.001). Thirty-eight patients in the deep NMB group (74%) showed optimal surgical conditions, whereas 16 patients in the moderate NMB group (30%) showed optimal endoscopic surgical conditions. No PORC and respiratory complications occurred in both groups, and no difference was found between the two groups in terms of recovery profiles, including recovery time and other adverse events.

Conclusions

Deep NMB and reversal with sugammadex improved the endoscopic surgical condition without complications compared with moderate NMB and reversal with sugammadex in patients undergoing TURB.

Hizli F, Argun G, Guney I, Guven O, Arik AI, Basay S, Gunaydin H, Basar H, Kosus A (2016) Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial. Ir J Med Sci 185:555–560CrossRefPubMed

Jo YY, Choi E, Kil HK (2011) Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB. Korean J Anesthesiol 61:143–147CrossRefPubMedPubMedCentral

Olsfanger D, Zohar E, Fredman B, Richter S, Jedeikin R (1999) Effect of spinal versus general anesthesia on bladder compliance and intraabdominal pressure during transurethral procedures. J Clin Anesth 11:328–331CrossRefPubMed

Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS (2008) Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 107:130–137CrossRefPubMed

Welliver M, McDonough J, Kalynych N, Redfern R (2009) Discovery, development, and clinical application of sugammadex sodium, a selective relaxant binding agent. Drug Des Dev Ther 2:49–59

Abrishami A, Ho J, Wong J, Yin L, Chung F (2010) Cochrane corner: sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade. Anesth Analg 110:1239PubMed

Choi ES, Oh AY, Koo BW, Hwang JW, Han JW, Seo KS, Ahn SH, Jeong WJ (2017) Comparison of reversal with neostigmine of low-dose rocuronium vs. reversal with sugammadex of high-dose rocuronium for a short procedure. Anaesthesia 72:1185–1190CrossRefPubMed

Huh H, Park SJ, Lim HH, Jung KY, Baek SK, Yoon SZ, Lee HW, Lim HJ, Cho JE (2017) Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery. Laryngoscope 127:1135–1139CrossRefPubMed

Koo BW, Oh AY, Seo KS, Han JW, Han HS, Yoon YS (2016) Randomized clinical trial of moderate versus deep neuromuscular block for low-pressure pneumoperitoneum during laparoscopic cholecystectomy. World J Surg 40:2898–2903CrossRefPubMed

10.

Martini CH, Boon M, Bevers RF, Aarts LP, Dahan A (2014) Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Br J Anaesth 112:498–505CrossRefPubMed

11.

Trevisani L, Cifala V, Gilli G, Matarese V, Zelante A, Sartori S (2013) Post-anaesthetic discharge scoring system to assess patient recovery and discharge after colonoscopy. World J Gastrointest Endosc 5:502–507CrossRefPubMedPubMedCentral

12.

Fredman B, Zohar E, Philipov A, Olsfanger D, Shalev M, Jedeikin R (1998) The induction, maintenance, and recovery characteristics of spinal versus general anesthesia in elderly patients. J Clin Anesth 10:623–630CrossRefPubMed

13.

Abrishami A, Ho J, Wong J, Yin L, Chung F (2009) Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade. Cochrane Database Syst Rev 4:CD007362

14.

Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Marymont JH, Vender JS, Gray J, Landry E, Gupta DK (2011) Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period. Anesthesiology 115:946–954CrossRefPubMed

15.

Martinez-Ubieto J, Ortega-Lucea S, Pascual-Bellosta A, Arazo-Iglesias I, Gil-Bona J, Jimenez-Bernardo T, Munoz-Rodriguez L (2016) Prospective study of residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. Minerva Anestesiol 82:735–742PubMed

Title: Comparison between the effects of deep and moderate neuromuscular blockade during transurethral resection of bladder tumor on endoscopic surgical condition and recovery profile: a prospective, randomized, and controlled trial
Authors: C. H. Koo
S. H. Chung
B. G. Kim
B. H. Min
S. C. Lee
A. Y. Oh
Y. T. Jeon
J. H. Ryu
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 2/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2398-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison between the effects of deep and moderate neuromuscular blockade during transurethral resection of bladder tumor on endoscopic surgical condition and recovery profile: a prospective, randomized, and controlled trial

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2019

Combination of solifenacin and tamsulosin may provide additional beneficial effects for ureteral stent-related symptoms—outcomes from a network meta-analysis

Suctioning ureteral access sheath use in flexible ureteroscopy might decrease operation time and prevent infectious complications

The value of periprostatic fascia thickness and fascia preservation as prognostic factors of erectile function after nerve-sparing robot-assisted radical prostatectomy

Oral quality of life after buccal mucosal graft harvest for substitution urethroplasty. More than a bite?

Inhibition of autophagy significantly increases the antitumor effect of Abiraterone in prostate cancer

Defining the target prior to prostate fusion biopsy: the effect of MRI reporting on cancer detection