Comparative study of rocuronium deep neuromuscle block in isofluorane and total intravenous anesthesia on peritoneal compliance and surgical conditions during laparoscopic cholecystectomy

Abstract

Laparoscopic surgery is commonly used in the treatment of gallstones. Deep relaxation leads to improved surgical outcomes by providing more successful surgical conditions. In this study, the effect of rocuronium-induced deep relaxation on abdominal compliance and surgeon satisfaction in intravenous and inhalation anesthesia methods is investigated. Materials and Methods: 70 candidate patients for laparoscopic cholecystectomy eligible for this study are randomly divided to intravenous (TIVA) and inhalation (IA) anesthesia groups after induction of anesthesia. In TIVA, propofol infusion is used at a dose of 60-100 μg/kg/min, and in IA, isoflurane is used with MAC of 1-2. For both groups, remifentanil infusion 0.1-0.05 μg/kg/min with oxygen and air mixture was used to maintain anesthesia, and muscle block was monitored to maintain TOF=2-4. After blowing carbon dioxide into the peritoneum and stabilizing the intra-abdominal pressure (IAP) below 15 mmHg, every 1 minute all the patient's symptoms, the satisfaction level of the surgeon and the quality of the operation conditions are monitored. After stabilization of IAP and data collection, rocuronium is injected at a dose of 0.3 mg/kg to provide TOF=0 and PTC=0 (deep relaxation). To investigate the changes caused by deep relaxation, the hemodynamic parameters (systolic and diastolic blood pressures and heart rate) are used from the absolute value of the difference of these parameters. To check the degree of abdominal wall relaxation, the xiphopubic distance (length of xiphoid to symphysis pubis) is measured in three stages, before induction (D1), after blowing carbon dioxide (D2) and after complete relaxation (D3). The level of satisfaction of the surgeon with the conditions of the operation due to the increase in the compliance of the abdomen and the comfort of the surgeon's work is recorded based on five criteria. At the end of surgery and until the TOF is above zero and receiving at least two responses, the anesthetic drugs are discontinued and antagonized with the usual doses of neostigmine and atropine, and after achieving spontaneous breathing, the patient is extubated and transferred to the recovery. The time to reach TOF from 0 to 2 is recorded, and after obtaining TOFR = 0.9 and Aldrete score of 10, the patient is discharged from recovery. The presence of nausea, vomiting, chills, the time of pain feeling, the intensity of pain, and the duration of the patient's discharge from entering the recovery room to transfer to the ward are recorded. Results: The average demographic data of the patients in the two groups were not significantly different and the conditions of the two groups were confirmed to be the same. The mean and frequency of most of the studied variables were the same in TIVA and IA groups and the observed differences were not statistically significant. The average changes in the number of heart rates in TIVA were significantly higher than IA, and the arterial oxygen saturation in IA was higher than TIVA.