Study objective: To assess whether different intensities of intra-abdominal pressure and deep neuromuscular blockade influence the risk of intra-operative surgical complications during laparoscopic... Show moreStudy objective: To assess whether different intensities of intra-abdominal pressure and deep neuromuscular blockade influence the risk of intra-operative surgical complications during laparoscopic donor nephrectomy.Design: A pooled analysis of ten previously performed prospective randomized controlled trials.Setting: Laparoscopic donor nephrectomy performed in four academic hospitals in the Netherlands: Radboudumc, Leiden UMC, Erasmus MC Rotterdam, and Amsterdam UMC.Patients: Five hundred fifty-six patients undergoing a transperitoneal, fully laparoscopic donor nephrectomy enrolled in ten prospective, randomized controlled trials conducted in the Netherlands from 2001 to 2017.Interventions: Moderate (tetanic count of four > 1) versus deep (post-tetanic count 1-5) neuromuscular blockade and standard (>= 10 mmHg) versus low (<10 mmHg) intra-abdominal pressure.Measurements: The primary endpoint is the number of intra-operative surgical complications defined as any deviation from the ideal intra-operative course occurring between skin incision and closure with five severity grades, according to ClassIntra. Multiple logistic regression analyses were used to identify predictors of intra- and postoperative complications.Main results: In 53/556 (9.5%) patients, an intra-operative complication with ClassIntra grade >= 2 occurred. Multiple logistic regression analyses showed standard intra-abdominal pressure (OR 0.318, 95% CI 0.118-0.862; p = 0.024) as a predictor of less intra-operative complications and moderate neuromuscular blockade (OR 3.518, 95% CI 1.244-9.948; p = 0.018) as a predictor of more intra-operative complications. Postoperative complications occurred in 31/556 (6.8%), without significant predictors in multiple logistic regression analyses.Conclusions: Our data indicate that the use of deep neuromuscular blockade could increase safety during laparoscopic donor nephrectomy. Future randomized clinical trials should be performed to confirm this and to pursue whether it also applies to other types of laparoscopic surgery. Show less
Muscle relaxation is routinely applied during general anaesthesia. The introduction of sugammadex brought new opportunities in perioperative neuromuscular management and patient care. Sugammadex... Show moreMuscle relaxation is routinely applied during general anaesthesia. The introduction of sugammadex brought new opportunities in perioperative neuromuscular management and patient care. Sugammadex is able to quickly and completely reverse any depth of neuromuscular block, which was not possible before. The unique properties of sugammadex enable the safe application of deep neuromuscular blockade during anaesthesia, and its intense reversal may reduce the overall incidence of postoperative residual neuromuscular blockade in the recovery ward. This thesis investigated the effect of deep neuromuscular blockade on surgical conditions in laparoscopic retroperitoneal surgery. In addition, outcome data of reversal strategies and of the everyday use of deep neuromuscular blockade are presented. Show less
