Deep versus moderate neuromuscular block during one-lung ventilation in lung resection surgery

Javier Casanova; Patricia Piñeiro; Francisco De La Gala; Luis Olmedilla; Patricia Cruz; Patricia Duque; Ignacio Garutti

doi:10.1016/j.bjane.2015.12.002

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Deep versus moderate neuromuscular block during one-lung ventilation in lung resection surgery

Bloqueio neuromuscular profundo versus moderado durante a ventilação monopulmonar em cirurgia de ressecção pulmonar

Javier Casanova; Patricia Piñeiro; Francisco De La Gala; Luis Olmedilla; Patricia Cruz; Patricia Duque; Ignacio Garutti

http://dx.doi.org/10.1016/j.bjane.2015.12.002 Braz J Anesthesiol, vol.67, n3, p.288-293, 2017

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Abstract

Abstract Background and objectives: Neuromuscular relaxants are essential during general anesthesia for several procedures. Classical anesthesiology literature indicates that the use of neuromuscular blockade in thoracic surgery may be deleterious in patients in lateral decubitus position in one-lung ventilation. The primary objective of our study was to compare respiratory function according to the degree of patient neuromuscular relaxation. Secondary, we wanted to check that neuromuscular blockade during one-lung ventilation is not deleterious. Methods: A prospective, longitudinal observational study was made in which each patient served as both treated subject and control. 76 consecutive patients programmed for lung resection surgery in Gregorio Marañon Hospital along 2013 who required one-lung ventilation in lateral decubitus were included. Ventilator data, hemodynamic parameters were registered in different moments according to train-of-four response (intense, deep and moderate blockade) during one-lung ventilation. Results: Peak, plateau and mean pressures were significantly lower during the intense and deep blockade. Besides compliance and peripheral oxygen saturation were significantly higher in that moments. Heart rate was significantly higher during deep blockade. No mechanical ventilation parameters were modified during measurements. Conclusions: Deep neuromuscular blockade attenuates the poor lung mechanics observed during one-lung ventilation.

Keywords

Neuromuscular block, One-lung ventilation, Lung resection surgery

Resumo

Resumo Justificativa e objetivos: Os relaxantes neuromusculares são essenciais durante a anestesia geral para vários procedimentos. A literatura clássica de anestesiologia indica que o uso de bloqueio neuromuscular em cirurgia torácica pode ser prejudicial em pacientes posicionados em decúbito lateral com ventilação seletiva. O objetivo primário deste estudo foi comparar a função respiratória de acordo com o grau de relaxamento neuromuscular do paciente. O objetivo secundário foi verificar que o bloqueio neuromuscular durante a ventilação seletiva não é prejudicial. Métodos: Estudo observacional, prospectivo e longitudinal no qual cada paciente serviu como próprio controle. Foram incluídos 76 pacientes consecutivos, agendados para cirurgia de ressecção do pulmão no Hospital Gregorio Marañon ao longo de 2013, submetidos à ventilação seletiva em decúbito lateral. Os dados do ventilador e os parâmetros hemodinâmicos foram registrados em diferentes momentos de acordo com a resposta por sequência de quatro estímulos (bloqueio intenso, profundo e moderado) durante a ventilação seletiva. Resultados: As pressões de pico, platô e média foram significativamente menores durante os bloqueios intenso e profundo. Além disso, complacência e saturação periférica de oxigênio foram significativamente maiores nesses momentos. A frequência cardíaca foi significativamente maior durante o bloqueio profundo. Não houve alteração dos parâmetros da ventilação mecânica durante as mensurações. Conclusões: O bloqueio neuromuscular profundo atenua a mecânica pulmonar deficiente observada durante a ventilação seletiva.

Palavras-chave

Bloqueio neuromuscular, Ventilação seletiva, Cirurgia de ressecção pulmonar

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Deep versus moderate neuromuscular block during one-lung ventilation in lung resection surgery

Bloqueio neuromuscular profundo versus moderado durante a ventilação monopulmonar em cirurgia de ressecção pulmonar

Javier Casanova; Patricia Piñeiro; Francisco De La Gala; Luis Olmedilla; Patricia Cruz; Patricia Duque; Ignacio Garutti

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