Deep neuromuscular blocking and sugammadex reversing-drug is an efficient strategy permitting successful laparoscopic surgery under low insufflation pressure: Prospective multicenter study

Figures & data

Table 1. Domains of the post-operative quality recovery scale for recovery from NMB ^[17].

Domain	The measured recovery parameters	Application
Physiologic	Physiologic recovery: systolic blood pressure, HR, temperature, respiratory rate, and oxygen saturation Emergence & airway safety: airway control, level of agitation & consciousness, and activity on command	Immediate PO Before PACU transfer Before hospital discharge
Nociceptive	Pain and nausea	Assessed using a 1–5 Likert rating scale at PACU admission, 4-h later & before hospital discharge
Emotional	Feelings of anxiety and depression
Activities of daily living	Assesses physical return to normalcy through the ability to stand, walk and dress without assistance, and to eat and drink	Scored as easily (=3), with difficulty (=2), and not at all (=1).
Cognitive	Assess orientation, verbal memory, executive functioning, attention, and concentration	Assessed before PACU & hospital discharge
Overall patient perspective	Patients rate their return to activities of daily living, clarity of thought, ability to work, and satisfaction with anesthetic care.	It is complementary to the other domains but is not included in the analysis of return to baseline

Figure 1. Study flow chart.

Table 2. Patients’ characteristic and demographic data in both groups.

		Group C (n=68)	Group D (n=67)	P
Age (years)		38.8±7.4	37.7±8.4	0.423
Gender	Males	18 (26.5%)	20 (29.9%)	0.662
	Females	50 (50%)	47 (70.1%)
Weight (kg)		84.9±5.6	84.1±6.4	0.417
Height (cm)		165.5±5.2	164.8±5	0.437
BMI (kg/m^2)		31±2.1	31±2.3	0.817
ASA grade	ASA-I	63 (92.6%)	60 (89.6%)	0.527
	ASA-II	5 (7.4%)	7 (10.4%)
Indication of Laparoscopic cholecystectomy	Chronic calcular cholecystitis	56 (82.3%)	54 (80.6%)	0.369
	Gall bladder polyp	5 (7.4%)	9 (13.4%)
	Both	7 (10.3%)	4 (6%)

Data are shown as mean, standard deviation, numbers and percentages.

Figure 2. Percentage of HR & MAP change with abdominal insufflation of patients of both groups.

Table 3. Patients’ intraoperative data.

			Group C (n=68)	Group D (n=67)	P
Heart rate (beats/min)	Before intubation		79.9±4.2	79.3±3.8	0.344
	After intubation		86.6±4.3	85.6±4	0.155
	Before insufflation		81±4.1	79.3±5.3	0.039
	After insufflation		89±3.6	86.2±4.9	<0.001
	% of change during insufflation		10±3.7	8.88±2.6	0.045
	After table tilting		84.5±4.6	79.9±4.4	<0.001
	After desufflation		80±4.7	79.8±3.9	0.848
	After intubation		84±4.1	85.5±3.8	0.010
Mean arterial pressure (mmHg)	Before intubation		88.2±3.1	87.9±3.2	0.465
	After intubation		92.5±3.1	92±3	0.263
	Before insufflation		86.6±3.3	85.8±3.1	0.142
	After insufflation		89.5±3.7	88.2±3.4	0.023
	% of change during insufflation		3.4±1.12	2.75±1.43	0.005
	After table tilting		84.2±4.6	84.1±3.3	0.751
	After desufflation		85.1±4.4	83.7±3.4	0.003
	After intubation		87.9±3.9	87.3±3	0.241
Operative field visibility scoring	Scores	2	3 (4.4%)	5 (7.5%)	0.609
		3	23 (33.8%)	28 (41.8%)
		4	27 (39.7%)	22 (32.8%)
		5	15 (22.1%)	12 (17.9%)
	Median (IQR) of score		4 [3–4]	4 [3–4]	0.238
Operative time (min)			27±6.7	29.4±8.3	0.068

Figure 3. Patient’s distribution according to the percentages of patients returned to normally of PQRS domains at time of hospital discharge.

Table 4. Time till recovery of NMB and PQRS scale data.

			Group C (n=68)	Group D (n=67)	P
Time till recovery of the train-of-four ratio to 0.9 after reversal agent injection (min)			8.7±1.46	2.71±0.5	<0.001
Physiologic domain (% of patients returned to baseline value)	NMB reversal		41 (60.3%)	54 (80.6%)	0.033
	PACU discharge		52 (76.5%)	60 (89.6%)	0.043
	Hospital discharge		62 (91.2%)	65 (97%)	0.151
Nociceptive domain (% of patients had no pain)	PACU admission		60 (88.2%)	64 (95.5%)	0.121
	4-h after PACU discharge		49 (72.1%)	58 (86.6%)	0.038
	Hospital discharge		54 (79.4%)	62 (92.5%)	0.028
Nociceptive domain (% of patients had no nausea)	PACU admission		57 (83.8%)	60 (89.6%)	0.328
	4-h after PACU discharge		53 (77.9%)	61 (91%)	0.036
	Hospital discharge		60 (88.2%)	65 (97%)	0.116
Emotional domain (% of patients had no anxiety or depression)	PACU admission		64 (94.1%)	65 (97%)	0.414
	4-h after PACU discharge		53 (77.9%)	61 (91%)	0.036
	Hospital discharge		56 (82.4%)	63 (94%)	0.036
Activities of daily living (% of patients easily performing daily activities)	At hospital discharge		56 (82.4%)	61 (91%)	0.216
	At D-1 PO		52 (76.5%)	60 (89.6%)	0.043
	At D-7 PO		46 (67.6%)	57 (85.1%)	0.017
Cognitive domain (% of patients regained normal cognitive functions)	PACU discharge		34 (50%)	38 (56.7%)	0.434
	Hospital discharge		47 (69.1%)	57 (85.1%)	0.028
	D-7 PO		60 (88.2%)	66 (98.5%)	0.017
Overall patients’ perspective (% of patients regained normalcy)	Hospital discharge		49 (72.1%)	58 (86.6%)	0.038
	D-7 PO		60 (88.2%)	66 (98.5%)	0.017
Aldrete score	Mean score		9.2±1.4	10±1.3	0.0015
	Frequency	<9	17 (25%)	7 (10.4%)	0.027
		≥9	51 (75%)	60 (89.6%)

D-1: Day 1.

Figure 4. Surgeon’s distributionn according to their satisfaction by the applied procedure NMB & AIP.

Table 5. Patients’ postoperative data.

			Group C (n=68)	Group D (n=67)	P
NRS pain scores	PACU		0 [0–1]	0 [0–1]	0.327
	1-h		1 [1–1]	1 [1–1]	0.418
	2-h		1 [1–1]	2 [1–2]	0.00026
	3-h		2 [1–2]	2 [1–2]	0.0251
	4-h		2 [2–3]	2 [2–3]	0.873
	8-h		3 [2–4]	2 [2–3]	0.078
	12-h		3 [2–4]	2 [1–3]	0.034
	16-h		2 [1–4]	2 [1–3]	0.056
	20-h		2 [1–3]	1 [0–2]	0.233
	24-h		1 [1–3.5]	1 [1–2]	0.303
The lapsed PO duration till	1^st oral ambulation (min)		117±17.5	108±19.7	0.006
	1^st oral intake (h)		3.3±0.83	3±0.7	0.025
	Hospital discharge (h)		8.5±1.9	8±2.1	0.157
Postoperative nausea & vomiting	Incidence of nausea	Yes	15 (22.1%)	6 (9%)	0.035
		No	53 (77.9%)	61 (91%)
	Nausea score		2.07±0.7	1.33±0.52	0.033
	Incidence of vomiting		0	0	0
Surgeons’ satisfaction score	Frequency according to score	Very dissatisfied	0	0	0.047
		Dissatisfied	2 (3%)	4 (6%)
		Good	20 29.4%)	7 (10.4%)
		Satisfied	15 (22.1%)	19 (28.4%)
		Very satisfied	31 (45.5%)	37 (55.2%)
	Median value (IQR)		2 [2–3]	1 [1–2]	0.056
Shoulder-tip pain (STP)	Frequency	Yes	22 (32.4%)	10 (14.9%)	0.017
		No	46 (67.6%)	57 (85.1%)
	Median NRS STP score (IQR)		5 [4–6]	4 [3–5]	0.034

Royse CF, Newman S, Chung F, et al. Development and feasibility of a scale to assess postoperative recovery: the post-operative quality recovery scale. Anesthesiology. 2010;113(4):892–905. doi: 10.1097/ALN.0b013e3181d960a9

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