Efficacy Of Deep Neuromuscular Blockade Combined With Low-pressure Pneumoperitoneum For Gynecological Laparoscopic Surgery In Obese Patients

Objective:To research and explore the feasibility and safety of deep and moderate neuromuscular blockade in laparoscopic surgery,and to compare the effect of deep and moderate neuromuscular blockade combined with different pneumoperitoneum pressures on laparoscopic hysterectomy,so to analyze the optimized degree of neuromuscular blockade and the optimized pressure of pneumoperitoneum in patients undergoing laparoscopic hysterectomy.To ensure the smooth progress of the operation and to ensure the safety of patients’ lives.Methods:90 patients scheduled for elective laparoscopic hysterectomy in our hospital were selected as the research subjects,and the patients were randomly divided into three groups using a random number table method:group A(deep NMB plus low-pressure pneumoperitoneum),group B(moderate NMB plus low-pressure pneumoperitoneum),group C(moderate NMB plus high-pressure pneumoperitoneum).During the induction phase of the anesthesia,three-fold ED95 bolus was administered to facilitate tracheal intubation.The ventilation mask was used to remove nitrogen and provide oxygen until TOFr equal to 0.During the maintenance phase of the anesthesia,TOF or PTC was used to monitor the degree of neuromuscular blockade and ccording to the results of monitoring,wo adjust the rate of infusion to maintain the target.Satisfaction with surgical field,the abdominal pain,shoulder pain,therecovery index and time for TOFr returning to 0.7 and 0.9,airway pressure and hemodynamic changes,different impacts of neuromuscular blockade were evaluated.Results:Compared with group B,the satisfaction of surgical field was higher in group A and group C.Compared with group C,the VAS scores were significantly reduced at 1 h,4 h,8 h,and 16 h after surgery,the incidence of shoulder pain was significantly reduced at 8 h,24 h,and 48 h after surgery in group A and group B.Compared with group A,the recovery index and time for TOFr returning to 0.7 and 0.9 were significantly shorter in groups B and C.Compared with T0,the airway pressure,heart rate,and mean arterial pressure of the three groups were significantly increased at T1 and T2.Compared with group C,the airway pressure at T1 and T2 was lower and the differences in heart rate and mean arterial pressure were not significant in groups A and B.Conclusion:This study believes that deep neuromuscular blockade combined with low-pressure pneumoperitoneum and moderate neuromuscular blockade combined with high-pressure pneumoperitoneum can provide a satisfactory surgical field.The reduction of abdominal wall tension in the patients with deep neuromuscular blockade effectively increased the operating space.At the same time,low-pressure pneumoperitoneal has certain clinical significance for the function of respiratory,the stability of hemodynamic and the reduction of postoperative pain.Due to the effect of pressure-volume curve,the surgical operation space has been optimized in patients with high-pressure pneumoperitoneum.Combined withmoderate neuromuscular blockade,it is helpful for rapid recovery after surgery.