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World Journal of Urology

, Volume 37, Issue 2, pp 359–365 | Cite as

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

  • C. H. Koo
  • S. H. Chung
  • B. G. Kim
  • B. H. Min
  • S. C. Lee
  • A. Y. Oh
  • Y. T. Jeon
  • J. H. RyuEmail author
Original Article

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.

Keywords

Bladder cancer Endoscopic surgery Neuromuscular blockade Surgical space condition 

Abbreviations

ASA

American Society of Anesthesiologists physical status classification

BMI

Body mass index

PACU

Post-anesthetia care unit

PTC

Post-tetanic count

TOF

Train-of-four

Notes

Acknowledgements

This work was supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinion in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp.

Author contributions

CHK manuscript writing/editing. SHC data collection and management. BGK data collection and management. BHM protocol development and editing. SCL scoring endoscopic surgical condition. AYO Protocol development and revision. YTJ data collection and analysis. JHR protocol development and data analysis, manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

Dr. C. H. Koo, S. H. Chung, B. G. Kim, B. H. Min, S. C. Lee, A. Y. Oh, Y. T. Jeon and J. H. Ryu have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

References

  1. 1.
    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 185:555–560CrossRefGoogle Scholar
  2. 2.
    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 61:143–147CrossRefGoogle Scholar
  3. 3.
    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 11:328–331CrossRefGoogle Scholar
  4. 4.
    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 107:130–137CrossRefGoogle Scholar
  5. 5.
    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 2:49–59Google Scholar
  6. 6.
    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 110:1239Google Scholar
  7. 7.
    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 72:1185–1190CrossRefGoogle Scholar
  8. 8.
    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 127:1135–1139CrossRefGoogle Scholar
  9. 9.
    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 40:2898–2903CrossRefGoogle Scholar
  10. 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 112:498–505CrossRefGoogle Scholar
  11. 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 5:502–507CrossRefGoogle Scholar
  12. 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 10:623–630CrossRefGoogle Scholar
  13. 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:CD007362Google Scholar
  14. 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 115:946–954CrossRefGoogle Scholar
  15. 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 82:735–742Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • C. H. Koo
    • 1
    • 2
  • S. H. Chung
    • 1
    • 3
  • B. G. Kim
    • 1
    • 3
  • B. H. Min
    • 3
  • S. C. Lee
    • 4
  • A. Y. Oh
    • 1
    • 3
  • Y. T. Jeon
    • 1
    • 3
  • J. H. Ryu
    • 1
    • 3
    Email author
  1. 1.Department of Anesthesiology and Pain MedicineSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Anesthesiology and Pain Medicine, CHA Bundang Medical CenterCHA University School of MedicineSeongnamSouth Korea
  3. 3.Department of Anesthesiology and Pain MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
  4. 4.Department of UrologySeoul National University Bundang HospitalSeongnamSouth Korea

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