Effect of different muscle relaxation degree on perioperative complications and survival rate of elderly patients undergoing laparoscopic colorectal cancer resection
Objective To compare the effect of different levels of neuromuscular blockade on perioperative complications and survival rates in elderly patients undergoing laparoscopic radical resection for colorectal cancer.Methods A total of 60 patients who were scheduled for elective laparoscopic radical resection for colorectal cancer were selected.According to the random number ta-ble method,the patients were divided into two groups(n=30):a moderate neuromuscular blockade group(group M)and a deep neuro-muscular blockade group(group D).Both groups underwent laparoscopic colorectal cancer resection under total intravenous anesthesia.Ingroup M,train-of-four(TOF)counts were maintained at 1-2,with pneumoperitoneum pressure at 12-14mmHg(1 mmHg=0.133 kPa).In group D,TOF counts were maintained at 0,with post-tetanic count of 1-2,and pneumoperitoneum pressure at 8-10 mmHg.Both groups received the same anesthetic agents and intraoperative management protocols,while postoperative patient-controlled analgesia(PCA)was used.Their general data[gender ratio,age,body mass index(BMI),American Society of Anesthesiologists(ASA)classifica-tion,and anesthesia time]were recorded for both groups.Furthermore,intraoperative propofol,remifentanil,and norepinephrine dosag-es,time from drug withdrawal to extubation,pneumoperitoneum pressure,and pneumoperitoneum duration were also recorded.The length of postoperative hospitalization stay,Numeric Rating Scale(NRS)scores at resting and during exercises at postoperative 24,48 h,and 72 h,the incidence of postoperative nausea and vomiting(PONV)at postoperative 24,48 h,and 72 h,and postoperative complica-tions were recorded.The quality of recovery at postoperative 2 years were evaluated by the EuroQol 5 Dimension(EQ-5D),while EQ-5D index,overall survival(OS),progression-free survival(PFS),and survival rates were recorded.Results There were no statis-tical differences in general information between the two groups(all P＞0.05).There were also no statistical differences between the two groups in intraoperative propofol and norepinephrine dosages,time from drug withdrawal to extubation,or pneumoperitoneum duration(all P＞0.05).Patients in group D required less remifentanil and lower pneumoperitoneum than group M(all P＜0.05).There were no sta-tistical differences between the two groups in the length of postoperative hospitalization stay,NRS scores at resting and during exercises at postoperative 24,48 h and 72 h,the incidence of PONV at postoperative 24,48 h,and 72 h,postoperative complications,EQ-5D in-dex at postoperative 2 years,overall survival,progression-free survival,or survival rates(all P＞0.05).Conclusions In elderly colorectal cancer patients undergoing laparoscopic surgery,maintaining different levels of neuromuscular blockade does not affect the incidence of postoperative complications or long-term survival rates.Both moderate and deep neuromuscular blockade can be safely ap-plied.
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