Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Deep neuromuscular block (NMB) and opioid-free anaesthesia (OFA) improve surgical workspace and reduce post-operative opioid consumption, but its impact on perioperative outcomes is unknown. This observational study compared complications and healthcare resource utilization after bariatric surgery, with or without continuous deep NMB or OFA.
We included all 9246 patients who underwent laparoscopic bariatric surgery at our institution from January 2009 to February 2017. Continuous clinical deep NMB was defined as receiving a continuous infusion of rocuronium with a dose of > 1 mg/kg IBW for each hour or sugammadex > 2 mg/kg total body weight at the time of reversal. We analysed the effect of continuous clinical deep NMB and OFA and covariates on 1 month post-operative complications using the Clavien-Dindo (CD) classification (grades II–V) and healthcare utilization (hospital length of stay [LOS], rates of reoperations within 1 week, high-dependency care unit admissions, and readmissions within 1 month). Covariates included experience of the attending anaesthesiologist, patient age, sex, body mass index, American Society of Anesthesiologists physical status score, obstructive sleep apnoea syndrome, diabetes, hypertension, surgery type, surgical team experience, and neostigmine use.
OFA, continuous deep NMB, surgical and anaesthesia team experience, younger age, and surgery type were associated with fewer complications. OFA was associated with lower healthcare resource utilization. Reduced LOS was also associated with younger age, surgical team experience, and surgery type, but not continuous deep NMB.
Continuous deep NMB and OFA were associated with fewer complications after bariatric surgery.
Dillemans B, Sakran N, Van Cauwenberge S, et al. Standardization of the fully stapled laparoscopic Roux-en-Y gastric bypass for obesity reduces early immediate postoperative morbidity and mortality: a single center study on 2606 patients. Obes Surg. 2009;19:1355–64. CrossRef
Aceto P, Modesti C, Sacco T, et al. Patient-related factors predicting workspace conditions during laparoscopic bariatric surgery. Obes Surg. 2018;28:3172–6. CrossRef
Madsen MV, Staehr-Rye AK, Gätke MR, et al. Neuromuscular blockade for optimizing surgical conditions during abdominal and gynaecological surgery: a systematic review. Acta Anaesthesiol Scand. 2015;59:1–16. CrossRef
Mulier J, Dillemans B. Deep neuromuscular blockade versus remifentanil or sevoflurane to augment measurable laparoscopic workspace during bariatric surgery analysed by a randomized controlled. Trial J Clin Anesth Pain Med. 2018;2:014.
Bruintjes MH, van Helden EV, Braat AE, et al. Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis. Br J Anaesth. 2017;118:834–42. CrossRef
Blobner M, Frick C, Stauble R, et al. Neuromuscular blockade improves surgical conditions (NISCO). Surg Endosc. 2015;29:627–36. CrossRef
Koninckx PR, Gomel V, Ussia A, et al. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril. 2016;106:998–1010. CrossRef
Thorell A, MacCormick A, Awad S, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) society recommendations. World J Surg. 2016;40:2065–83. CrossRef
Lavand'homme P, Steyaert A. Opioid-free anesthesia opioid side effects: tolerance and hyperalgesia. Best Pract Res Clin Anaesthesiol. 2017;31:487–98. CrossRef
Hayhurst CJ, Durieuw ME. Differential opioid tolerance and opioid-induced hyperalgesia. Anesthesiology. 2016;124:483–8. CrossRef
Roberts GW, Bekker TB, Carlsen HH, et al. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005;101:1343–8. CrossRef
Özdemir-van Brunschot DMD, Scheffer GJ, van der Jagt M, et al. Quality of recovery after low-pressure laparoscopic donor nephrectomy facilitated by deep neuromuscular blockade: a randomized controlled study. World J Surg. 2017;41:2950–8. CrossRef
Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23:2050–7. CrossRef
Mary Lynn McPherson Demystifying opioid conversion calculations: a guide for effective dosing. ISBN 978-1-58528-198-5 2009 American Society of Health-System Pharmacists, Inc.
Mulier J, Wouters R, Dillemans B, et al. A randomized controlled, double-blind trial evaluating the effect of opioid-free versus opioid general anaesthesia on post-operative pain and discomfort measured by the QoR-40. J Clin Anesth Pain Med. 2018;2:015.
Gallart L, Canet J. Post-operative pulmonary complications: understanding definitions and risk assessment. Best Pract Res Clin Anaesthesiol. 2015;29:315e330. CrossRef
Mulier J, Dubois P. A review of the interest of sugammadex for deep neuromuscular blockade management in Belgium. Acta Anaesthsiol Belg. 2013;64:49–60.
Moerer O, Bittner J, Hinz J, et al. Effect of rocuronium on the diaphragm, musculus adductor pollicis and orbicularis oculi in two groups of different age. Anasthesiol Intensivmed Notfallmed Schmerzther. 2005;40:217–24. CrossRef
Rosenberg J, Herring WJ, Blobner M, et al. Deep neuromuscular blockade improves laparoscopic surgical conditions: a randomized, controlled study. Adv Ther. 2017;34:925–36. CrossRef
Baykara N, Sahin T, Alpar R, et al. Evaluation of intense neuromuscular blockade caused by rocuronium using posttetanic count in male and female patients. J Clin Anesth. 2003;15:446–50. CrossRef
Rotava P, Cavalcanti IL, Barrucand L, et al. Effects of magnesium sulphate on the pharmacodynamics of rocuronium in patients aged 60 years and older: a randomised trial. Eur J Anaesthesiol. 2013;30:599–604. CrossRef
Moerer O, Bittner J, Hinz J, et al. Neuromusculare Wirkzeiten von Rocuronium am diaphragma, Musculus adductor pollicis und orbicularis oculi in zwei altersgruppen. Anaesthesiol Intensivmed Notfallmed Schmerzther. 2005;40:217–24. CrossRef
Stourac P, Adamus M, Seidlova D, et al. Low-dose or high-dose rocuronium reversed with neostigmine or sugammadex for cesarean delivery anesthesia: a randomized controlled noninferiority trial of time to tracheal intubation and extubation. Anesth Analg. 2016;122:1536–45. CrossRef
Gurusamy K, Vaughan J, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD006930.
- Anaesthetic Factors Affecting Outcome After Bariatric Surgery, a Retrospective Levelled Regression Analysis
Jan P. Mulier
- Springer US
The Journal of Metabolic Surgery and Allied Care
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
Neu im Fachgebiet Chirurgie
Mail Icon II