Baete, Sam

De Deyne, C

Jans, F

Van Zundert, J

Vander Laenen, M

Vanelderen, P

Ghent University Academic Bibliography

4 General AnaesthesiologyThis open label dose optimization study of dual-stage 30min ABP-700 infusion regimens was performed in 56 subjects in combination with bolus FEN pre-treatment (n = 32) or REMI co-infusions (n = 24). A total of 8 cohorts of 4 or 8 subjects were completed. Doses were selected based on previous studies to produce sub-hypnotic through occasional deep sedative ef fect.Safety assessments included clinical labs, hemodynamic, respiratory and ad-verse event (AE) monitoring. PD ef fect was measured using MOAA/S and the BIS monitor.Results and discussion: Subjects were male (48%) or female (51%) and pre-dominantly white (89%) with ages ranging from 18-55 years. ABP-700 was safe and well tolerated with the majority of AEs reported as mild. At the low-est dose tested, mild BIS deflections were recorded but not associated with clinical sedation ef fect. Escalating dose regimens demonstrated a steep dose dependent increase in sedation ef fect as measured by both BIS and MOAA/S. For subjects who were deeply sedated (MOAA/S <2), co-infusion of REMI resulted in apnea in 3 subjects but in none of the subjects receiving FEN pre-medication. Recovery was rapid accross all cohorts tested with 100% of subjects fully recovered within 10min of infusion completion.Conclusions: ABP-700 was safe and well tolerated at all doses tested. Dose dependent PD ef fect was observed with escalating doses of ABP-700. FEN or REMI administration did not significantly alter the profile of ABP-700. Respiration was generally well preserved with apnea events occurring infre-quently in deeply sedated subjects receiving REMI. These data suggest that ABP-700 can safely produce levels of sedation ranging from light/moderate to deep and support the further exploration of ABP-700 in a procedural sedation set ting. 01AP01-4Comparison of deep vs. moderate neuromuscular blockade on low-pressure pneumoperitoneum for laparoscopic cholecystectomyBarrio J.1, Molina I.1, Chiralt A.2, San Miguel G.1, Errando C.L.3, Gallego J.41Hospital Arnau de Vilanova (Valencia), Dept of Anaesthesiology, Valencia, Spain, 2Hospital Arnau de Vilanova (Valencia), Dept of Surgery, Valencia, Spain, 3Consorcio Hospital General Universitario de Valencia, Dept of Anaesthesiology, Valencia, Spain, 4Universit y of Valencia, Dept of Surgery, Valencia, SpainBackground and Goal of Study: Clinical and experimental studies have re-ported outcome advantages of low-pressure (<9mmHg) vs. standard-pres-sure (12-14 mmHg) pneumoperitoneum for laparoscopic surgery. However, working with low-pressure pneumoperitoneum can limit working space and surgical conditions could be worse. The aim of this study was to assess the influence of neuromuscular blockade(NMB) depth on performing low-pressure pneumoperitoneum lapa-roscopic cholecystectomy(LC)Materials and methods: Randomized, double blinded clinical trial. Ninety patients scheduled for elective LC were randomly allocated into three groups: Group 1: low-pressure LC (8mmHg) with deep NMB (TOF 0, PTC <5); group 2: low-pressure LC (8mmHg) with moderate NMB (TOF 1-3) andgroup 3: standard-pressure LC (12 mmHg) with no NMB depth pre-deter-mined (control group). Three experienced surgeons (blinded to intraabdominal pressure (IAP) set-ting) performed all the surgeries and judged surgical conditions according to a 4-step scale (from 1-optimal to 4-not acceptable, the surgery cannot be performed in these conditions). Operating time and intraoperative complica-tions were investigated. Rocuronium was used for NMB and sugammadex was used for reversal of NMB. Acceleromiography was used for NMB monitor-ing (TOF-WATCH-S).Results and discussion: Group 3 showed statistically bet ter surgical condi-tions (p=0.021 Chi2) and a higher proportion of optimal conditions (p=0.007 Chi2) than groups 1 and 2. No dif ferences on surgical conditions (p=0.236 Chi2) or operating time (p=0.737 t test) were observed between groups 1 and 2. Four patients in group 1 and one patient in group 2 had bad surgical condi-tions (scoring 4) and IAP needed to be increased to 12 mmHg in order to perform the surgery (p=0.353 Fisher). No cases scoring 4 were observed in group 3. No complications of bleeding or bile duct injury were observed, however the rate of gallbladder perforation was higher at low-pressure LC (groups 1 and 2) when compared to standard-pressure LC (group 3) (p=0.018 Chi2).Conclusion(s): We did not observe better surgical conditions when per-forming low-pressure LC with deep NMB compared with moderate NMB. The rate of bad surgical-conditions and complications, patients that needed to increase the IAP for performing the surgery and operating time were not dif ferent at both NMB levels. Surgical conditions were judged better when performing LC at 12 mmHg pneumoperitoneum than at 8 mmHg, unrelated to NMB level. 01AP01-5The effect of deep versus moderate neuromuscular block on postoperative respiratory function in bariatric laparoscopic surgery: a randomized, double blind clinical trialBaete S., Vander Laenen M., Van Zundert J., Jans F., De Deyne C., Vanelderen P.Ziekenhuis Oost-Limburg, Dept of Anaesthesiology, Genk, BelgiumBackground and Goal of the Study: In recent literature it is has been sug-gested that deep neuromuscular block (NMB) improves surgical conditions during laparoscopy. The ef fect of deep NMB on postoperative respiratory function was not investigated in laparoscopic bariatric surgery. We investi-gated the respiratory function af ter anaesthesia with deep NMB and moderate NMB. This study was funded by MSD.Materials and methods: Eligible patients were >18 years of age and were obese (BMI>30kg/m2) or morbidly obese (BMI>40kg/m2) and scheduled to undergo laparoscopic gastric bypass surgery. Patients were stratified accord-ing to their BMI and evenly randomized over a deep NMB-group (rocuronium bolus and infusion maintaining a posttetanic count of 1-2, reversal with su-gammadex 4mg/kg) and a moderate NMB-group (rocuronium bolus and top-ups maintaining a train-of-four count of 1-2, reversal with neostigmine 50µg/kg and glycopyrolate). Anaesthesia was induced and maintained with propofol and remifentanil. In both groups patients were extubated when the TOF-ratio was >0.9. The primary outcome measure was the postoperative pulmonary function assessed by peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) and measured with an elec-tronic portable peak flow meter. Data are presented as mean±SEM.Results and discussion: Af ter IRB approval and obtaining informed con-sent, 60 patients were included in the study. Af ter surgery, all the pulmonary function tests were considerably impaired in both groups when compared to baseline (see Table 1). There was no statistically significant dif ference in the decrease in PEF, FEV1 and FVC (expressed as % change from baseline) between the deep and the moderate NMB-group (51.3±6.0% vs. 51.5±3.5%; P=0.97, 45.2±6.9% vs. 48.8±3.6%; P=0.64, 51.9±3.1% vs. 49.0±4.2%; P=0.29, respectively). In the deep NMB-group, 2 patients required postop-erative non-invasive CPAP vs. 1 patient in the moderate NMB-group (P=0.6). No patient needed reintubation af ter surgery.Pulmonary function testsDeep NMB-group P-value Moderate NMB-group P-value Pre-operativePost-operative Pre-operativePost-operative PEF (l/min) 314±20 141±15 P<0.0001 276±15 126±0.1 P<0.0001FEV1 (l) 2.4±0.2 1.1±0.1 P<0.0001 2.2±0.1 1.1±0.1 P<0.0001FVC (l) 3.0±0.2 1.4±0.1 P<0.0001 2.7±0.1 1.2±0.1 P<0.0001[Table 1. Pulmonary function tests]Conclusions: Pulmonary function is significantly impaired af ter laparoscopic bariatric surgery irrespective of the NMB-regime as long as NMB is adequate-ly monitored and reversed at the end of surgery. 

The effect of deep versus moderate neuromuscular block on postoperative respiratory function in bariatric laparoscopic surgery : a randomized, double blind clinical trial

https://biblio.ugent.be/publication/8615907/file/8615908

The effect of deep versus moderate neuromuscular block on postoperative respiratory function in bariatric laparoscopic surgery : a randomized, double blind clinical trial

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