Automated Quantitative Relaxometry for Deep Neuromuscular Blockade in Robot-Assisted Prostatectomy

Area of Science:

• Anesthesiology
• Robotic Surgery
• Pharmacology

Background:

• Deep neuromuscular block (NMB) is crucial for robot-assisted prostatectomy under pneumoperitoneum (PP).
• New relaxometry devices enable precise monitoring and maintenance of profound NMB.
• Optimizing NMB can enhance patient safety and surgical conditions.

Purpose of the Study:

• To evaluate the efficacy of automated quantitative relaxometry in maintaining a deep neuromuscular block during robot-assisted prostatectomy.
• To assess rocuronium dosing strategies for achieving and sustaining profound NMB throughout pneumoperitoneum.
• To correlate NMB depth with surgical conditions and patient safety.

Main Methods:

• Twenty adult patients undergoing robot-assisted prostatectomy were studied.
• Automated quantitative relaxometry (TOFcuffTM) guided rocuronium dosing to maintain deep NMB.
• Time fractions of intense block (PTC 0), adequate block (PTC 1-3), and insufficient block (PTC > 3) were quantified.

Main Results:

• An optimally deep block (PTC 1-3) was maintained for 50% of PP time (110 ± 38 min).
• Intense block (PTC 0) occurred for 27% (60 ± 45 min), and insufficient block (PTC > 3) for 23% (60 ± 45 min).
• No inadvertent movements were observed, and surgeons reported excellent operating conditions.

Conclusions:

• Controlled profound NMB using repetitive bolus doses achieved the target block for 77% of PP time.
• Automated quantitative relaxometry allows optimized rocuronium dosing for safety and surgical conditions.
• This approach avoids unnecessary prolongation of NMB post-operatively.