During robotic laparoscopic surgery, a high intraperitoneal pressure may result in high airway pressure and inadequate perfusion of the abdominal organs, and as a result the postoperative outcomes. Degree of neuromuscular blockade (NMB) can affect the intraperitoneal pressure. In this study, the patients undergoing robotic laparoscopic surgery will be assigned to deep NMB group and moderate NMB group. Perioperative outcomes including maximal intraperitoneal pressure, maximal intraoptic pressure, quality of emergence, postoperative pain, and incidence of postoperative respiratory complication will be compared. The results of this study will provide evidence for optimizing NMB protocol of robotic laparoscopic surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
192
rocuronium is a neuromuscular blocking agent with a duration of 40 minutes
rocuronium is continuously infused
rocuronium is intermittently given
incidence of postoperative major respiratory complications
incidence of pneumonia and atelectasis
Time frame: from end of surgery to discharge, at an average of 4 days
maximal airway pressure
airway pressure is titrated to as low as possible as long as the end tidal carbon dioxide partial pressure is lower than 40 mmHg
Time frame: from establishment of pneumoperitoneum to end of pneumoperitoneum, at an average of 3 hours
minimal cerebral oxygen saturation
cerebral oxygen saturation is continuously monitored during surgery
Time frame: from start of surgery to end of surgery, at an average of 3.5 hours
maximal intraocular pressure
intraocular pressure is monitored every 10 minutes during surgery
Time frame: from start of surgery to end of surgery, at an average of 3.5 hours
number of surgeon asking for improving muscle relax
when the surgeon is unsatisfied with the muscle relax, he can tell the anesthetist
Time frame: from start of surgery to end of surgery, at an average of 3.5 hours
time to extubation
criteria of extubation: spontaneous respiratory rate\>10 per minute and end tidal carbon dioxide partial pressure\<45mmHg
Time frame: from end of sevoflurane inhalation to extubation, at an average of 20 minutes
incidence of nausea and vomiting in post-anesthesia care unit
Time frame: from admittance to post-anesthesia care unit(PACU) to discharge from PACU, at an average of 30 minutes
incidence of shoulder pain in 24 hours after surgery
Time frame: from end of surgery to 24 hours after surgery
incidence of residual neuromuscular blockade in the post-anesthesia care unit
residual neuromuscular blockade is defined as time of head-lift or limb-lift\<10 seconds
Time frame: from admittance to post-anesthesia care unit(PACU) to discharge from PACU, at an average of 30 minutes
visual analogue scale at 24 hours after surgery
the patients are asked to mark the score they feel, 0 is no pain,100 is untolerated pain
Time frame: end of surgery to 24 hours after surgery
expense after surgery
the expense from immediately after surgery to discharge
Time frame: end of the surgery to discharge,at an average of 4 days
satisfaction score of the patients
the patient is asked to give a score between 0 and 10, 0 means not satisfied,10 means totally satisfied.
Time frame: from end of surgery to discharge,at an average of 4 days
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