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The Intraocular Pressure under Deep versus Moderate Neuromuscular Blockade during Low-Pressure Robot Assisted Laparoscopic Radical Prostatectomy in a Randomized Trial

Authors
 Young-Chul Yoo ; Na Young Kim ; Sun Joon Bai ; HeeJoon Park ; Chan Yun Kim ; Jung Hwa Hong ; Young Deuk Choi ; Seokyung Shin 
Citation
 PLoS One, Vol.10(8) : e0135412, 2015 
Journal Title
 PLoS One 
ISSN
 1932-6203 
Issue Date
2015
Abstract
BACKGROUND: This study aimed to determine whether continuous deep neuromuscular blockade (NMB) improves the surgical conditions and facilitates robotic-assisted laparoscopic radical prostatectomy (RALRP) under low intra-abdominal pressure (IAP) to attenuate the increase in intraocular pressure (IOP) during CO2 pneumoperitoneum in the steep Trendelenburg (ST) position. METHODS: Sixty-seven patients undergoing RALRP were randomly assigned to a moderate NMB group (Group M), including patients who received atracurium infusion until the end of the ST position, maintaining a train of four count of 1-2; and the deep NMB group (Group D), including patients who received rocuronium infusion, maintaining a post-tetanic count of 1-2. IOP was measured in all patients at nine separate time points. All RALRPs were performed by one surgeon, who rated the overall and worst surgical conditions at the end of the ST position. RESULTS: The highest IOP value was observed at T4 (60 min after the ST position) in both Group M (23.3 ± 2.7 mmHg) and Group D (19.8 ± 2.1 mmHg). RALRP was accomplished at an IAP of 8 mmHg in 88% Group D patients and 25% Group M patients. The overall surgical condition grade was 4.0 (3.0-5.0) in Group D and 3.0 (2.0-5.0) in Group M (P < 0.001). CONCLUSION: The current study demonstrated that continuous deep NMB may improve surgical conditions and facilitate RALRP at a low IAP, resulting in significant attenuation of the increase on IOP. Moreover, low-pressure pneumoperitoneum, facilitated by deep NMB still provided acceptable surgical conditions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02109133.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/141056
DOI
10.1371/journal.pone.0135412
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Anesthesiology and Pain Medicine
1. 연구논문 > 1. College of Medicine > Dept. of Urology
1. 연구논문 > 1. College of Medicine > Dept. of Ophthalmology
1. 연구논문 > 1. College of Medicine > Yonsei Biomedical Research Center
Yonsei Authors
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