Key result
Deep neuromuscular blockade yielded a lower low-frequency/high-frequency ratio at operation end vs moderate blockade (1.4 vs 2.2; p=0.039), but no significant differences in stress biomarkers.
Why the study?
Attenuating intraoperative stress response is crucial, but the effect of neuromuscular blockade on surgical stress is not completely understood.
Does deep neuromuscular blockade reduce perioperative stress response in patients undergoing robot-assisted gastrectomy compared to moderate neuromuscular blockade?
RCT
Double-blind
Randomized
Does deep neuromuscular blockade reduce perioperative stress response in patients undergoing robot-assisted gastrectomy compared to moderate neuromuscular blockade?
Deep neuromuscular blockade alters intraoperative heart rate variability but does not significantly affect stress-related biological markers compared to moderate blockade during robot-assisted gastrectomy.
Answers are grounded in this paper and cite their sources.
Deep blockade lowers HRV ratio without biomarker changes; leaves open net perioperative stress benefit in robotic gastrectomy.
Attenuating the intraoperative stress response is crucial; however, the effect of neuromuscular blockade (NMB) on surgical stress is not completely understood. We aimed to investigate the effects of NMB on the perioperative stress response during robot-assisted gastrectomy. Patients were assigned to the deep or moderate NMB group. Serum cortisol, prolactin, and interleukin-6 (IL-6) levels and natural killer (NK) cell percentage were measured before anesthesia induction, 90 min after pneumoperitoneum, operation end (OPEnd), and postoperative day 1. Additionally, C-reactive protein (CRP) and albumin levels were estimated. Additionally, intraoperative heart rate variability was evaluated. The deep NMB group showed significantly lower levels of low-frequency/high-frequency (HF) ratio at OPEnd compared to the moderate NMB group (1.4 ± 0.2 vs. 2.2 ± 0.3, respectively; Bonferroni corrected p = 0.039). Furthermore, HF power in the deep NMB group was significantly higher at OPEnd than that in the moderate NMB group (45.2 ± 3.6 vs. 33.8 ± 4.0, respectively; Bonferroni corrected p = 0.044). However, no significant differences in cortisol, prolactin, IL-6, CRP, and albumin levels and NK cell percentage were found between the two groups. The degree of NMB may have similar effects on stress-related biological markers in patients undergoing robot-assisted gastrectomy.
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Kim et al. (2021) conducted an RCT in Robot-assisted gastrectomy. Deep neuromuscular blockade vs. Moderate neuromuscular blockade was evaluated on Low-frequency/high-frequency ratio at operation end (p=0.039). Deep neuromuscular blockade yielded a lower low-frequency/high-frequency ratio at operation end vs moderate blockade (1.4 vs 2.2; p=0.039), but no significant differences in stress biomarkers.
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