Comparison of Deep and Moderate Neuromuscular Blockade for Major Laparoscopic Surgery in Children: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Neuromuscular blocking agents are routinely used in laparoscopic surgery to optimize operative conditions. We compared the effect of a deep and moderate neuromuscular blockade (NMB) on surgical conditions and postoperative outcomes in children undergoing major laparoscopic surgery. METHODS: Sixty children aged 2-14 years scheduled to undergo major laparoscopic surgery were randomly allocated to deep (post-tetanic count 1-2 twitches) or moderate (train-of-four 1-2 twitches) NMB groups. The anesthesia was maintained with propofol and remifentanil, and the NMB was maintained with a rocuronium continuous infusion. At the end of the operation, the NMB were antagonized with sugammadex. The intra-abdominal pressure, airway pressure, Leiden Surgical Rating Scale, intraoperative hemodynamics, drug usages, duration of surgery, postoperative recovery time, pain, and complications were compared between the groups. RESULTS: The maximum and mean intra-abdominal pressure, the peak inspiratory pressure, and mean airway pressure were significantly lower in the deep NMB group than in the moderate NMB group (p < 0.001). The Leiden Surgical Rating Scale and the dosage of rocuronium were significantly higher in the deep NMB group than the moderate NMB group (p < 0.001). The intraoperative hemodynamics, duration of surgery, post-operative recovery time, pain, and the incidence rate of complications were not significantly different between the groups (p > 0.05). CONCLUSIONS: A deep NMB provided better operative conditions and similar recovery profiles compared with a moderate NMB as reversed with sugammadex in children undergoing major laparoscopic surgery. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry, No. ChiCTR2100053821.

Dexmedetomidine Improves Non-rapid Eye Movement Stage 2 Sleep in Children in the Intensive Care Unit on the First Night After Laparoscopic Surgery.

Background: Previous studies have reported that children who were admitted to the ICU experienced a significant decrease in sleep quality compared to home. We investigated the effects of dexmedetomidine as an adjunct to sufentanil on the sleep in children admitted to the ICU on the first night after major surgery. Methods: This is a prospective study From January to February 2022. Clinical trial number: ChiCTR2200055768, http://www.chictr.org.cn. Fifty-four children aged 1-10 years old children undergoing major laparoscopic surgery were recruited and randomly assigned to either the DEX group, in which intravenous dexmedetomidine (0.3 ug/kg/h) and sufentanil (0.04 ug/kg/h) were continuously infused intravenously for post-operative analgesia; or the SUF group, in which only sufentanil (0.04 ug/kg/h) was continuously infused. Patients were monitored with polysomnography (PSG) on the first night after surgery for 12 h. PSG, sleep architecture, physiologic variables and any types of side effects related to anesthesia and analgesia were recorded. The differences between the two groups were assessed using the chi-square and Wilcoxon rank-sum tests. Results: Fifty-four children completed data collection, of which thirty-four were 1-6 years old and twenty were aged >6 years. Compared to the SUF group, subjects in the DEX group aged 1-6 years displayed increased stage 2 sleep duration (P = 0.02) and light sleep duration (P = 0.02). Subjects aged >6 years in the DEX group also displayed increased stage 2 sleep duration (P = 0.035) and light sleep duration (P = 0.018), but decreased REM sleep percentage (P = 0). Additionally, the heart rate and blood pressure results differed between age groups, with the heart rates of subjects aged >6 years in DEX group decreasing at most time points compared to SUF group (P < 0.05). Conclusion: Dexmedetomidine prolonged N2 sleep and light sleep duration in the pediatric ICU after surgery but had different effects on the heart rate and blood pressure of subjects in different age groups.

Comparison of sufentanil-midazolam and sevoflurane for anesthesia induction in children undergoing cardiac surgery by real-time hemodynamic and cardiac efficiency monitoring: A prospective randomized study.

Background Intravenous sufentanil-midazolam and inhalational sevoflurane are widely used for anesthetic induction in children undergoing cardiac surgery. However, knowledge about their effects on hemodynamics and cardiac efficiency remains limited due largely to the lack of direct monitoring method. We used minimally invasive technique pressure recording analytical method (PRAM) to directly monitor hemodynamics and cardiac efficiency and compared the effects of the two anesthetic regimens in children undergoing ventricular septal defect repair. Methods Forty-Four children (2.3±0.9 years) were randomly divided into two groups to receive either intravenous sufentanil (1 µg/kg) and midazolam (0.2 mg/kg) (Group SM) or 2.0 minimal alveolar concentration (MAC) sevoflurane (Group S) to complete induction after sedation was obtained with 2.0 MAC sevoflurane. Systemic hemodynamic data recorded by PRAM included heart rate (HR), systolic (SBP) and mean (MBP) blood pressure, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) and cardiac cycle efficiency (CCE) after sedation obtained, 1, 2, 5 min after induction achieved, 1, 2, 5 and 10 min after intubation. Results HR, SVRI showed a decrease in Group SM but an increase in Group S (Ptime*group<0.0001) in the study period. SVI and CCE showed an increase in Group SM but a decrease in Group S (Ptime*group<0.0001). SBP, MBP and CI were related to time after polynomial transformation, and showed an increase after intubation in Group SM but a decrease in Group S (Ptime2*group<0.0001). Conclusion PRAM provides meaningful and direct monitoring of hemodynamics and cardiac efficiency during the dynamic period of anesthetic induction in children undergoing cardiac surgery. As compared to inhalational sevoflurane, intravenous sufentanil-midazolam exerts more favorable effects on systemic hemodynamics and cardiac efficiency during anesthetic induction in this group of patients.