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Abstract Background Conflicting data exist regarding the effects of deep neuromuscular blockade (NMB) on abdominal dimensions during laparoscopic procedures. We performed a clinical study to establish the influence of moderate and deep neuromuscular blockade (NMB) on the abdominal working space, measured by Magnetic Resonance Imaging (MRI), during laparoscopic donor nephrectomy with standard pressure (12 mmHg) pneumoperitoneum under sevoflurane anaesthesia. Methods Ten patients were intraoperatively scanned three times in the lateral decubitus position, with pneumoperitoneum maintained by a mobile insufflator. The first scan without NMB (T1) was followed by scans with moderate (T2) and deep NMB (T3). The skin-sacral promontory (S-SP) distance was measured, and 3D pneumoperitoneum volumes were reconstructed. Results The mean difference in the S-SP distance was -0.32 cm between T2 and T3 (95% CI -1.06 - 0.42 cm; p = 0.344) and + 2.1 cm between T1 and T2 (95% CI 0.81 - 3.39 cm; p = 0.006). The mean differences in pneumoperitoneum volume were 166 mL between T2 and T3 (95% CI, 5 - 327 mL; p = 0.044) and 108 mL between T1 and T2 (95% CI, -273 - 488 mL; p = 0.525). The pneumoperitoneum volume showed high inter-individual variability and no increase in three patients with a high volume at T1. Conclusions During laparoscopic surgery in the lateral decubitus position with standard pressure under sevoflurane anaesthesia, deep NMB did not increase the S-SP distance compared to moderate NMB. Moderate NMB increased the S-SP distance by a mean of 2.1 cm (15.2%) compared with no NMB. The mean pneumoperitoneum volume increased slightly from moderate to deep NMB, with high inter-individual variability. Trial registration Clinicaltrials.gov ID: NCT03287388.

BackgroundFew studies have examined the effect of epidural block on surgical conditions during pediatric subumbilical laparoscopic surgery involving a supraglottic airway (SGA). This study investigated the surgical condition scores for such procedures in cases where neuromuscular block, epidural block, or neither was used.MethodsA total of 150 patients aged 3–12 years undergoing laparoscopic orchiopexy with a ProSeal SGA device were randomly allocated to one of three groups: the control group (did not receive neuromuscular block and epidural block), the NMB group [received a neuromuscular block (train-of-four 1–2 twitches) using rocuronium], or the EDB group (received an epidural block using ropivacaine). The primary outcome was the quality of surgical conditions evaluated with the Leiden-Surgical Rating Scale by the blinded surgeon. The secondary outcome measures included intraoperative hemodynamic data (including mean arterial pressure and heart rate), the SGA device removal time, the PACU discharge time, the pain score in the PACU and intraoperative adverse events (including bradycardia, hypotension, peak airway pressure > 20 cmH2O, and poor or extremely poor surgical conditions occurred during the operation). Statistical analysis was performed with one-way analysis of variance, the Kruskal–Wallis test, the chi-square test or Fisher’s exact test. Bonferroni corrections for multiple comparisons were made for primary and secondary outcomes.ResultsSurgical condition scores were significantly higher in the NMB and EDB groups than in the control group (median difference: 0.8; 95% confidence interval [CI], 0.5–1.0; p

Abstract Background Globally, 10% of neonatal mortality in low-/middle-income countries (L/MIC) is directly attributed to surgical conditions, and appropriate referral and transport of newborns to tertiary-level hospitals for surgical care often underlie their survival. This study aimed at evaluating the outcomes of newborns with surgical conditions in a low-resource setting, in the context of a structured standard operating procedure (SOP) for newborn transport. Methods A cluster randomized controlled trial was conducted. Ten county hospitals that refer newborns with surgical conditions to the Moi Teaching and Referral Hospital (MTRH) were selected and randomized into intervention group (A) and control group (B). A structured standard operating procedure (SOP) for transport of newborns was introduced in the hospitals in group A via an education module. Thereafter, 126 newborns (63 in group A and 63 in group B) were enrolled, upon their admission to the MTRH. All the newborns from both groups of referring hospitals were given standard surgical care upon admission. Data on study variables was collected and analyzed, and the outcomes of the newborns in the two groups were compared to assess the effect of the structured SOP. Results The median age at admission was 4.1 days in group A and 4.6 days in group B. The top 4 surgical conditions were gastroschisis, hydrocephalus, Hirschsprung’s disease, and anorectal malformations. There was a statistically significant difference (p

Abstract Background and aims Deep neuromuscular blockade (NMB) is known to improve surgical conditions, compared to moderate neuromuscular blockade (NMB), which is expected to improve postoperative quality of recovery (QOR). However, it is unknown whether deep NMB improves postoperative QOR in ambulatory gynecologic laparoscopy. Therefore, we compared the effects of deep and moderate NMB on postoperative QOR in ambulatory gynecologic laparoscopy. Methodology We included 80 female in this study. They were randomized into 2 equal groups: deep NMB (dNMB) and moderate NMB (mNMB) at constant pneumoperitoneum pressure of 12 mmHg. The primary outcome was QOR-40 at 24 h, and the secondary outcomes were duration of surgery, surgical rating scale (SRS) score, time to home discharge readiness, pain scores, and tramadol consumption. Results The SRS scores were significantly higher in dNMB group, compared with mNMB. Mean (95% CI) SRS scores in deep NMB were 4.55 (4.52-4.58) versus 4.15 (4.11-4.19) in moderate NMB, p = 0.03. However, there was no significant difference between the two groups in the QoR-40 scores, and other secondary outcomes. Conclusion We found no difference between deep and moderate NMB on postoperative QOR after ambulatory gynecologic laparoscopy. Therefore, deep NMB during ambulatory gynecologic laparoscopy may be unnecessary, at least in non-obese patients. Trial registration This study was registered at www.clinicaltrials.gov ( NCT04105764 ).

Introduction: Subjective estimation of neuromuscular block (NMB), focused on clinical signs such as visual and tactile estimation, can be very difficult and conducted only on awake patients. Hence, it seems that usage of NMB's objective monitoring should become a component of anaestesiological equipment. Objective: The objective was to establish whether application of acceleromyography using the post-tetanic number method (PTC) for NMB's monitoring creates better conditions for surgical work in comparison to subjective, clinical monitoring of NMB. Materials and methods: This randomized clinical study included 40 patients, operated in the General surgery clinic of Clinical center in Nis. Patients were divided into 2 groups consisting of 20 patients each (n=20). Subjective, clinical monitoring of NMB was used on patients in the first group (ESMkon) in all phases of anaesthesiological flow, while PTC mode (TOF Watch® S) based acceleromyographical monitoring in different phases of NMB was used on the patients in the second group (ESMptc). The conditions were qualitatively graded as acceptable and non acceptable, as well as exceptional, satisfying and difficult, and they were mutually compared between examined groups. Statistical significance is estimated with Fisher's exact test and taken as p

Background: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. Patients and Methods: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome. Results: Out of 7,401 neonates admitted within the study period, 460 (6.2%) had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8%) of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7%) of all the surgical cases. Intestinal obstruction 129 (31.6%), neural tube defects 101 (24.8%) and anterior abdominal wall defect 58 (14.2%) were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8%) and perforated NEC 14 (26.9%) were the commonest acquired conditions. Surgery was performed in 166 (36.1%) and 98 (59%) had postoperative complications. Significantly, more deaths occurred in preterms than in term babies (P = 0.003) and in those delivered outside the hospital than in in-born babies (P = 0.02). The major cause of death was infection in 92 (47%). Conclusion: Neonatal surgical conditions contributed significantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries.