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Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery

 H. J. Kim  ;  K. Lee  ;  W. K. Park  ;  B. R. Lee  ;  H. M. Joo  ;  Y. W. Koh  ;  Y. W. Seo  ;  W. S. Kim  ;  Y. C. Yoo 
 BRITISH JOURNAL OF ANAESTHESIA, Vol.115(6) : 867-872, 2015 
Journal Title
Issue Date
Adult ; Aged ; Androstanols/administration & dosage* ; Anesthesia, General/methods ; Dose-Response Relationship, Drug ; Female ; Humans ; Larynx/surgery* ; Male ; Microsurgery/adverse effects ; Microsurgery/methods* ; Middle Aged ; Monitoring, Intraoperative/methods ; Neuromuscular Blockade/methods* ; Neuromuscular Junction/drug effects ; Neuromuscular Junction/physiopathology ; Neuromuscular Nondepolarizing Agents/administration & dosage* ; Prospective Studies ; Young Adult
larynx ; neuromuscular blockade ; neuromuscular monitoring
BACKGROUND: Adequate neuromuscular block is required throughout laryngeal microsurgery. We hypothesized that the surgical conditions would improve under a deeper level of rocuronium-induced neuromuscular block. METHODS: Seventy-two patients undergoing laryngeal microsurgery were randomly allocated to either the 'post-tetanic counts 1-2' (PTC1-2) group or the 'train-of-four counts 1-2' (TOFcount1-2) group according to the level of neuromuscular block used. Two different doses of rocuronium (1.2 or 0.5 mg kg(-1)) were used after anaesthetic induction, and two respective targets of neuromuscular block (post-tetanic counts ≤2 or train-of-four count of 1 or 2) were used. Surgical conditions were assessed by the surgeon using a five-point rating scale (extremely poor/poor/acceptable/good/optimal), and clinically acceptable surgical conditions were defined as those which were rated acceptable, good, or optimal. The occurrence of vocal cord movement and postoperative adverse events was assessed. RESULTS: The surgical conditions were significantly different between the PTC1-2 and TOFcount1-2 groups (extremely poor/poor/acceptable/good/optimal: 0/2/1/7/26 and 3/10/2/14/7, respectively, P<0.001). The incidence of clinically acceptable surgical conditions was significantly higher in the PTC1-2 group than in the TOFcount1-2 group (94 vs 64%, P=0.003). The percentage of patients who exhibited vocal cord movement was significantly lower in the PTC1-2 group than in the TOFcount1-2 group (3 vs 39%, P<0.001). The incidence of postoperative adverse events was not significantly different except for the less frequent occurrence of mouth dryness in the PTC1-2 group (P=0.035). CONCLUSIONS: Deep neuromuscular block (post-tetanic count of 1-2) surgical conditions in patients undergoing laryngeal microsurgery improves. CLINICAL TRIAL REGISTRATION: NCT01980069.
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1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kho, Yoon Woo(고윤우)
Kim, Won Shik(김원식)
Kim, Hyun Joo(김현주) ORCID logo https://orcid.org/0000-0003-1963-8955
Park, Wyun Kon(박윤곤)
Seo, Young Wook(서영욱)
Yoo, Young Chul(유영철) ORCID logo https://orcid.org/0000-0002-6334-7541
Lee, Ki Young(이기영) ORCID logo https://orcid.org/0000-0003-4893-3195
Lee, Bo Ra(이보라) ORCID logo https://orcid.org/0000-0002-7699-967X
Joo, Hyung Min(주형민)
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