The aim of this study is to investigate the effect of depth of neuromuscular blockade on the surgical field, patient postoperative pain, intestinal motility, the incidence of postoperative nausea and vomiting and the effect of deep versus moderate neuromuscular blockade on postoperative atelectasis quantitatively using chest computed tomography.This is a prospective, randomized, controlled clinical-controlled study in patients ≥18 years old scheduled to undergo elective bariatric surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
50
maintenance of a deep neuromuscular block with rocuronium, titrated to maintain a TOF count of 0, and a PTC between 1-2. Quality of surgical field conditions' assessed by a blind surgeon as a 5 points scale(Leiden scale : 1 indicates extremely poor conditions, 2 poor conditions, 3 acceptable conditions, 4, good conditions and 5 optimal conditions)
maintenance of a moderate neuromuscular block with rocuronium, titrated to maintain a TOF count of 1-2
impact of a deep neuromuscular blockade on surgical conditions
impact of a deep neuromuscular blockade (TOF count = 0 and posttetanic count \[PTC\] 1-2) and a moderate neuromuscular blockade (TOF count= 1 - 3) on intraoperative surgical conditions assessed by the surgeon as a 5 points scale
Time frame: During surgery
the effect of deep versus moderate neuromuscular blockade on postoperative atelectasis quantitatively using chest computed tomography.
quantitatively using chest computed tomography and expressed as percentage to total lung tissue volume
Time frame: in the first six postoperative hours
Postoperative pain
Pain was measured four times in the PACU (at 15 min intervals starting upon arrival) and twice on the ward (8PM the day of surgery and 2 PM the next day).Pain was measured using an 11-point numerical rating scale (NRS), ranging from 0 (no pain) to 10 (most pain imaginable).
Time frame: first postoperative day
Mean arterial pressure (mmHg)
measured before induction to general anesthesia, immediately after induction and every 15 min until the end of operation and immediately after awareness.at 15 min intervals starting upon arrival in the post anesthesia care unit
Time frame: intraoperative and in Postanesthesia care unit
PIPcmH20 ( Peak inspiratory pressure)
Respiratory mechanical parameters were measured after intubation at suspine position, after insufflation of pneumoperitoneum , then the standard different positions of the patient ( Anti-Trendelenburg, supine, anti-trendelenburg and suspine position without premoperitoneum at the end of the procedure)
Time frame: intraoperative
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duration of surgery (hr)
from the incision to the last skin suture
Time frame: intrapostoperative
The first flatus time (min)
the first time that patient flatus postoperative
Time frame: up to 5 days
duration of anesthesia time (min)
time from anesthesia induction to Extubation
Time frame: intraoperative
Postoperative nausea and vomiting (PONV)
incidence of PONV
Time frame: until first postoperative day
Hospitalization time ( days)
FROM ADMISSION TO HOSPITAL TO DISCHARGE
Time frame: up to 2 weeks
cumulative analgetid dose (mg)
cumulative analgetid dose until 2 PM the next day of the surgery
Time frame: until 2 PM the next day of the surgery
oxygen saturation (SpO2) %
measured before induction to general anesthesia, immediately after induction and every 15 min until the end of operation and immediately after awareness.at 15 min intervals starting upon arrival in the post anesthesia care unit
Time frame: intraoperative and in Postanesthesia care unit
tidal volume (ml)
Respiratory mechanical parameters were measured after intubation at suspine position, after insufflation of pneumoperitoneum , then the standard different positions of the patient ( Anti-Trendelenburg, supine, anti-trendelenburg and suspine position without premoperitoneum at the end of the procedure)
Time frame: Intraoperative
Pplat cmH20 ( plateau pressure),
Respiratory mechanical parameters were measured after intubation at suspine position, after insufflation of pneumoperitoneum , then the standard different positions of the patient ( Anti-Trendelenburg, supine, anti-trendelenburg and suspine position without premoperitoneum at the end of the procedure)
Time frame: Intraoperative
dynamic compliance ml/cmH20,
Respiratory mechanical parameters were measured after intubation at suspine position, after insufflation of pneumoperitoneum , then the standard different positions of the patient ( Anti-Trendelenburg, supine, anti-trendelenburg and suspine position without premoperitoneum at the end of the procedure)
Time frame: Intraoperative
DP cmH20( Driving pressure)
Respiratory mechanical parameters were measured after intubation at suspine position, after insufflation of pneumoperitoneum , then the standard different positions of the patient ( Anti-Trendelenburg, supine, anti-trendelenburg and suspine position without premoperitoneum at the end of the procedure)
Time frame: Intraoperative
Resistance cmH20/L/sec
Respiratory mechanical parameters were measured after intubation at suspine position, after insufflation of pneumoperitoneum , then the standard different positions of the patient ( Anti-Trendelenburg, supine, anti-trendelenburg and suspine position without premoperitoneum at the end of the procedure)
Time frame: Intraoperative
PEEP cmH20
Respiratory mechanical parameters were measured after intubation at suspine position, after insufflation of pneumoperitoneum , then the standard different positions of the patient ( Anti-Trendelenburg, supine, anti-trendelenburg and suspine position without premoperitoneum at the end of the procedure)
Time frame: Intraoperative