Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1405-1415
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1405
Utilization of deep neuromuscular blockade combined with reduced abdominal pressure in laparoscopic radical gastrectomy for gastric cancer: An academic perspective
Yi-Wei Zhang, Yong Li, Wan-Bo Huang, Jue Wang, Xing-Er Qian, Yu Yang, Chang-Shun Huang
Yi-Wei Zhang, Yong Li, Wan-Bo Huang, Jue Wang, Xing-Er Qian, Yu Yang, Chang-Shun Huang, Department of Anesthesiology, Ningbo First Hospital, Ningbo 315016, Zhejiang Province, China
Author contributions: Zhang YW and Li Y designed the study, contributed equally to this study, are considered as co-first authors; Zhang YW, Li Y, Huang WB, Wang J, and Qian XE conducted the research; Yang Y contributed to the analytical tools; Zhang YW, Li Y and Huang CS analyzed the data and wrote the manuscript; and all authors read and approved the final manuscript.
Supported by Zhejiang Health Science and Technology Plan 2022, No. 2022KY320.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Hospital of Ningbo (Ethical approval number: 2019R006).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no potential conflicts of interest.
Data sharing statement: Raw data and statistics are available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Shun Huang, MBChB, Chief Doctor, Department of Anesthesiology, Ningbo First Hospital, No. 59 Liuting Street, Haishu District, Ningbo 315016, Zhejiang Province, China. nbhcs1967@163.com
Received: March 14, 2023
Peer-review started: March 14, 2023
First decision: April 7, 2023
Revised: April 20, 2023
Accepted: June 2, 2023
Article in press: June 2, 2023
Published online: July 27, 2023
Processing time: 129 Days and 5.1 Hours
Abstract
BACKGROUND

Few studies have examined the specific efficacy of deep neuromuscular blockade (NMB) combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy (LRG) in the elderly.

AIM

To investigate the application effect of deep neuromuscular blockade (NMB) combined with reduced pneumoperitoneum pressure in LRG for gastric cancer (GC) in elderly patients and its influence on inflammation.

METHODS

Totally 103 elderly patients with GC treated in our hospital between January 2020 and January 2022 were retrospectively analyzed. Among them, 45 patients treated with surgery based on deep NMB and conventional pneumoperitoneum pressure were assigned to the control group, while the rest of the 58 patients who underwent surgery based on deep NMB and reduced pneumoperitoneum pressure were assigned to the observation group. The two groups were compared in the changes of the Leiden-surgical rating scale score, serum tumor necrosis fact-α (TNF-α) and interleukin 6 (IL-6) before and after therapy. The visual analogue scale (VAS) was adopted for evaluating the shoulder pain of patients at 8 h, 24 h and 48 h after the operation. The driving pressure of the two groups at different time points was also compared. Additionally, the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, residence time in the resuscitation room, TOF% = 90% time and post-anesthetic recovery room (PACU) stay time were all recorded, and adverse PACU-associated respiratory events were also recorded. The postoperative hospitalization time and postoperative expenses of the two groups were counted and compared.

RESULTS

No significant difference was found between the two groups at the time of skin incision, 60 minutes since the operation and abdominal closure after surgery (P > 0.05). The observation group exhibited significantly lower VAS scores than the control group at 24 and 48h after surgery (P < 0.05). Additionally, the observation group had significantly lower driving pressure than the control group at 5 min and 60 min after the establishment of pneumoperitoneum (P < 0.05). Additionally, the two groups were similar in terms of the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, residence time in the resuscitation room and TOF% = 90% time (P > 0.05), and the observation group showed significantly lower TNF-α and IL-6 Levels than the control group at 24 h after therapy (P < 0.05). Moreover, the incidence of adverse events was not significantly different between the two groups (P > 0.05), and the observation group experienced significantly less hospitalization time and postoperative expenses than the control group (P < 0.05).

CONCLUSION

Deep NMB combined with reduced pneumoperitoneum pressure can decrease the VAS score of shoulder pain and inflammatory reaction, without hindering the surgical vision and increasing adverse PACU-associated respiratory events, and can thus shorten the hospitalization time and treatment cost for patient.

Keywords: Deep neuromuscular blockade; Low pneumoperitoneum pressure; Elderly; Laparoscopy; Gastric cancer; Radical gastrectomy; Inflammation

Core Tip: Laparoscopic radical gastrectomy is a common operation for the treatment of gastric cancer (GC) with minimally invasive and rapid recovery. However, high pneumoperitoneum pressure during laparoscopic surgery has an adverse effect on the perioperative outcome of patients, especially in elderly patients. Deep muscle relaxation has been proved to improve the conditions of abdominal surgery and reduce postoperative pain, but it is still unclear whether deep muscle relaxation combined with low pneumoperitoneum pressure is effective in laparoscopic radical resection of GC in the elderly. In this study, we analyzed the role of deep muscle relaxation combined with low pneumoperitoneum pressure in elderly patients undergoing laparoscopic radical gastrectomy for GC and its effect on inflammation, in order to provide a reference for clinicians to choose treatment options.