Effects of sugammadex on respiratory function of elderly gastric cancer patients received laparoscopic radical gastrectomy by antagonizing different degrees of neuromuscular blockade combined with different pneumoperitoneum pressures
Objective To investigate the effect of sugammadex on respiratory function of elderly gastric cancer patients received laparoscopic radical gastrectomy by antagonizing different degrees of neuromuscular blockade combined with different pneumoperitoneum pressures.Methods A total of 84 elderly patients received laparoscopic radical gastrec-tomy for gastric cancer in the First Affiliated Hospital of Ningbo University from March 2020 to June 2023 were selected and divided into group A[deep neuromuscular blockade(NMB)+low-pressure pneumoperitoneum],group B(deep NMB+routine pressure pneumoperitoneum)and group C(moderate NMB+routine pressure pneumoperitoneum)by random number table method,each with 28 patients.During the operation,the CO2 pneumoperitoneum pressure and post-tetanic count(PTC)were maintained at 10 mmHg(1 mmHg=0.133 kPa)and 1-2,respectively in group A,while 14 mmHg and 1-2,respectively in group B.In group C,the CO2 pneumoperitoneum pressure was maintained at 14 mmHg and train-of-four(TOF)count was maintained at 1-2.After the surgery,patients in groups A and B were antagonized by sugammadex,and in group C,they were antagonized by neostigmine.The three groups were compared in mean arterial pressure(MAP),heart rate(HR),plateau pressure(Pplat),peak pressure(Ppeak),and pulmonary dynamic compliance(Cdyn)while entering the operating room(T0),at 5 min after intubation(T1),5 min after pneumoperitoneum(T2),30 min after pneumoperitoneum(T3),1 h after pneumoperitoneum(T4),and 5 min after the end of pneumoperitoneum(T5),as well as in postoerative blood gas analysis indexes(pH,PaO2,PaCO2),extubation time,muscle relaxation recovery time,respiratory adverse events in the postanesthesia care unit(PACU)after extubation,postoperative pulmonary complications(PPCs),and length of postoperative hospital stay.Results There were no significant differences in MAP and HR among the three groups at each time point(all P＞0.05).However,after a long period of anesthesia,the MAP and HR were both significantly lower than those before anesthesia in each group(all P＜0.05).The Pplat and Ppeak in group A at T2,T3 and T4 were significant lower than those of groups B and C,while the Cdyn was higher(all P＜0.05).Meanwhile,the Pplat and Ppeak at T2,T3 and T4 in each group were significant higher than those at T,and T5,while the Cdyn was significant lower(all P＜0.05).The extubation time and muscle relaxation recovery time in groups A and B were significant shorter than those of group C,and the respiratory adverse events in PACU were less than group C(all P＜0.05).There were no significant differences in postoperative blood gas analysis,PPCs and length of postoperative hospital stay among the three groups(all P＞0.05).Conclusion Deep NMB combined with low-pressure pneumoperitoneum in elderly patients received laparoscopic radical gastrectomy for gastric cancer can reduce the Pplat and Ppeak,and improve the Cdyn.The use of sugammadex antagonism after surgery can shorten postoperative muscle relaxation recovery time and extubation time,and reduce respiratory adverse events in PACU.
SugammadexDeep neuromuscular blockadeLow-pressure pneumoperitoneumRespiratory function
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