Perioperative Effects of Induction with High-dose Rocuronium during Laparoscopic Cholecystectomy.

Area of Science:

• Anesthesiology
• Surgical Safety
• Pharmacology

Background:

• Laparoscopic cholecystectomy requires adequate surgical conditions, often influenced by intra-abdominal pressure (IAP).
• Neuromuscular blocking agents like rocuronium are used to facilitate endotracheal intubation and surgical relaxation.
• Optimizing anesthetic protocols can enhance surgical safety and patient recovery.

Purpose of the Study:

• To evaluate the impact of high-dose rocuronium on intra-abdominal pressure (IAP) during laparoscopic cholecystectomy.
• To assess the effect of high-dose rocuronium on surgical conditions and operative time.
• To determine the incidence of postoperative nausea and vomiting (PONV) and pain following surgery.

Main Methods:

• A randomized study comparing high-dose (1.2 mg/kg) versus standard-dose (0.6 mg/kg) rocuronium in patients undergoing laparoscopic cholecystectomy.
• Monitoring of intraoperative train of four (TOF) ratio and post-tetanic count (PTC).
• Evaluation of IAP, surgical field quality, PONV at 4, 12, and 24 hours, and pain scores at 2 and 24 hours, and 3 days.

Main Results:

• No significant demographic or hemodynamic differences between groups.
• Significantly lower IAP in the high-dose rocuronium group during the initial 20 minutes of surgery.
• Shorter operation duration (29.00±7.39 min vs. 34.63±12.00 min, p=0.044) and reduced PONV within the first 12 hours in the high-dose group.

Conclusions:

• High-dose rocuronium facilitates laparoscopic cholecystectomy with lower IAP compared to standard doses.
• Deep neuromuscular blockade induced by high-dose rocuronium can shorten operation duration.
• This anesthetic strategy effectively reduces postoperative nausea, vomiting, and pain.