| Background:Enhanced recovery after surgery(ERAS)protocols have been widely implemented for the improved outcomes.However,the protocols have not been utilized in simultaneous pancreas-kidney(SPK)transplantation considering the potential perioperative risks for SPK recipients,and no related trial has been reported up to date.In order to promote rehabilitation of patients undergoing SPK surgery,a multidisciplinary enhanced recovery program(ERAPKS)during SPK transplantation was designed on the basis of best available clinical evidence.As an important part of ERAS,the influence of accurate neuromuscular blockade management on the formulation of ERAPKS is worth exploringObjective:The purpose of this study was to evaluate the feasibility of ERAS protocols for SPK surgery,to analyze the safety and clinical significance of the Sugammadex reversing deep neuromuscular blockade(dNMB)for SPK recipients,and finally to achieve consensus on formulation of the ERAPKS strategy.Method and results:This randomized controlled trial(RCT)was conducted in the Second Affiliated Hospital of Guangzhou Medical University from October 2017 to May 2022,which analyzed 156 patients who underwent elective SPK surgery.1.108 patients underwent elective SPK surgery were randomly divided into ERAS group(E)and routine care group(T).The ERAS group was consisted of evidencedbased systematic optimization approaches,while the control group received routine care.Results:Group E compared with group T,the postoperative length of stay(LoS)(27.2 ± 6.5 vs 39.6± 9.7 days,P<0.05),hospitalization costs(43.6± 11.2 vs 59.4 ± 13.6 ten thousand yuan,P<0.05),48 hours post-operative analgesia score(NRS)(0.8± 0.5 vs 2.7 ± 1.1,P<0.05),the incidence of post-operative nausea and vomiting(PONV)(8.9%vs 22.2%,P<0.05),urinary catheter removal time by 7 days(8.9%vs 22.2%,P<0.05),post-operative gastric tube indwelling time[4(2,6)vs 7(4,9)days,P<0.05],the incidence of ambulation within 6 days(75.6%vs 31.1%,P<0.05).Compared with group T,the dosage of dobutamine using in group G was higher(P<0.05),the dosage of norepinephrine using was lower(P<0.05),and the total amount of fluid and urine volume were significantly increased(P<0.05).In group E,MAP was significantly increased(P<0.05)and lactate level was significantly decreased(P<0.05)at T2-T4.Glu,AMS,Scr and CCr in group E at T5-T8 were significantly recovered to normal reference range(P<0.05).Peak systolic velocity(PSV)and(resistance index)RI of grafts were found no significant difference between two groups(P>0.05).2.48 patients underwent elective SPK surgery were randomly divided into Sugammadex group(S)and neostigmine group(N).Compared with T0-1,Scr was significantly decreased at T2-6(P<0.01),while CCr was significantly increased(P<0.05).There was no significant difference in Scr,CCr and AMS at the same timepoint between both groups(P>0.05).MAP,HR and Glu in group S were significantly higher than those in group N at T1(P<0.05).Compared with group N,TOFr recovered to 0.7:[3(2.4-4.2)min vs 12.1(10.2-15.9)min,P<0.001]and TOFr recovered to 0.9:[4.8(3.6-7.1)min vs 23.5(19.8-30.8)min,P<0.001],incidence of admission to ICU[0 vs 2(8.4%),P<0.05],group S had a lower risk of post-operative pulmonary complications(P<0.01):supplemental oxygen requirements 0(0%)vs 4(16.7%),pulmonary atelectasis 0(0%)vs 2(8.4%),pneumonia 1(4.2%)vs 3(12.5%)and hypoxemia 1(4.2%)vs 4(16.7%).PSV and RI were found no significant difference between two groups at early post-operative stage.Conclusions:1.Implementation of ERAPKS is feasible,which can significantly shorten postoperative LoS,decrease hospitalization costs and complications,GDFT is beneficial for maintaining hemodynamic stability in SPK recipients is according with the ERAPKS.2.The safety and efficacy of 4mg·kg-1 sugammadex administration for reversing dNMB in SPK surgery is confirmed,appropriate management of neuromuscular blockade is beneficial to the formulation and improvement of ERAPKS scheme. |
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