Name: deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy
Uploaded: 2013-06-25T12:00:00
Description: Watch this Scientific Journal Video about Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy at JoVE.com

1。病例报告<ol><li>病人被设置为访问在妇科门诊中，常因出血性疾病的发生。进行体检。 <ol><li>如果认为适当，病人定了子宫切除术。文书工作准备，并给病人手术当天术前用药。 </li><li> 60岁及以上的患者必须先提交血液样本，并监测心电图（ECG）的程序之前。 </li></ol></li><li>在当天的手术，病人是不允许的消耗六个小时在入场前向任何经口。 <ol><li>一个例外是甜清晰不带果肉的饮料，这是允?...

<ol>
	<li>Jones, R. K., Caldwell, J. E., Sorin, C. B., Brull, J., Soto, R. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reversal+of+Profound+Rocuronium-induced+Blockade+with+Sugammadex.">Reversal of Profound Rocuronium-induced Blockade with Sugammadex.</a> Anesthesiology. 109, 816-824 (2008).</li><li>Berg, H., Roed, J., Viby-Mogensen, J., Mortensen, C. R., Enfbaek, J., Skovgaard, L. T., Krintel, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+neuromuscular+block+is+a+risk+factor+for+post-operative+pulmonary+complications:+A+prospective,+randomized,+and+blinded+study+of+postoperative+pulmonary+complications+after+atracurium,+vecuronium+and+pancuronium.">Residual neuromuscular block is a risk factor for post-operative pulmonary complications: A prospective, randomized, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium.</a> Acta Anaesthesiol. Scand. 41, 1095-1103 (1997).</li><li>Abrishami, A., Ho, J., Wong, J., Yin, L., Chung, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sugammadex,+a+selective+reversal+medication+for+preventing+postoperative+residual+neuromuscular+blockade.">Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.</a> The Cochrane Collaborations. , (2009).</li><li>Plaud, B., Debaene, B., Donati, F., Marty, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+Paralysis+after+Emergence+from+Anesthesia.">Residual Paralysis after Emergence from Anesthesia.</a> Anesthesiology. 112, 1013-1022 (2010).</li><li>Lee, D. W., Kim, M. J., Lee, Y. K., Lee, H. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+Intraabdominal+Pressure+Affect+Development+of+Subcutaneous+Emphysema+at+Gynecologic+Laparoscopy?.">Does Intraabdominal Pressure Affect Development of Subcutaneous Emphysema at Gynecologic Laparoscopy?.</a> Minimally Invasive Gynecology. , 761-765 (2011).</li><li>Sandhu, T., Yamada, S., Ariyakachon, V., Chakrabandhu, T., Chongruksut, W., Ko-iam, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low-pressure+pneumoperitoneum+versus+standard+pneumoperitoneum+in+laparoscopic+cholecystectomy,+a+prospective+randomized+clinical+trial.">Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial.</a> Surg. Endosc. 23, 1044-1047 (2009).</li><li>Sarli, L., Coisti, R., Sansebastiano, G., Trivelli, M., Roncoroni, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+randomized+trial+of+low-pressure+pneumoperitoneum+for+reduction+of+shoulder-tip+pain+following+laparoscopy.">Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy.</a> British Journal of Surgery. 87, 1161-1165 (2000).</li><li>Kandil, T. S., El Hefnawy, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shoulder+pain+following+laparoscopic+cholecystectomy:+factors+affecting+the+incidence+and+severity.">Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity.</a> J. Laparoendosc. Adv. Surg. Tech. A. 8, 677-682 (2010).</li><li>Mulier, J. P., Dillemans, B. R. S., Crombach, M., Missant, C., Sels, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=On+the+abdominal+pressure+volume+relationship.">On the abdominal pressure volume relationship.</a> The internet Journal of Anesthesiology. 21, (2009).</li><li>Srvastava, A., Niranjan, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Secrets+of+safe+laparoscopic+surgery:+Anaesthetic+and+surgical+considerations.">Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations.</a> J. Minim. Access. Surg. 6, 91-94 (2010).</li><li>Grosse-Sundrup, M., Henneman, J. P., Sandberg, W. S., Bateman, B. T., Uribe, J. V., Nguyen, N. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intermediate+acting+non-depolarizing+neuromuscular+blocking+agents+and+risk+of+postoperative+respiratory+complications:+prospective+propensity+score+matched+cohort+study.">Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study.</a> BMJ. 345, e6329 (2012).</li><li>Kaneko, G., Miyajima, A., Yazawa, S., Yuge, K., Kikuchi, E., Asanuma, H., Nakagawa, K., Oya, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+the+predictor+of+prolonged+operative+time+during+laparoscopic+radical+prostatectomy?.">What is the predictor of prolonged operative time during laparoscopic radical prostatectomy?.</a> Int. J. Urol. 20 (3), 330-336 (2012).</li><li>Drahonovsky, J., Haakova, L., Otcenasek, M., Krofta, L., Kucera, E., Feyereisl, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+randomized+comparison+of+vaginal+hysterectomy,+laparoscopically+assisted+vaginal+hysterectomy,+and+total+laparoscopic+hysterectomy+in+women+with+benign+uterine+disease.">A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease.</a> Eur. J. Obstet. Gynecol. Reprod. Biol. 148 (2), 172-176 (2010).</li></ol>

<html>直接计算工作容积，可用腹腔镜手术是困难的，但吹入CO 2的压力和腹部体积之间的关系是比较容易衡量9。这里，我们提出的方法是使用外科抓取器内的空间，来估计在注气过程中腹部，作为一种替代的方法记录吹入CO 2的体积。 这些测量表明，它有可能保持一个稳定的量，当充气压力降低，并诱发了深刻的神经肌肉阻滞。 一个明显?...

常用的神经肌肉阻断剂促进气管插管，麻醉过程中，以方便手术。药理学试剂的使用达到深层放松整个腹腔镜手术允许外科医生或者继续在同一水平的CO 2吹入，同时受益于更好的手术条件，或降低吹入压力降低手术并发症的风险。几项研究已经表明降低工作压力5,6,7的正面效应。腹腔镜子宫切除手术后经常看到的一个症状是肩部疼痛，经常说作为一个主要问题，最重要的问题，对病人说话时跟进。 腹腔镜子宫肌瘤剔除术或子宫切除术通常是更保守的方法失败时，建议控制由子宫肌瘤引起的症状。在我们的机构中​​，这些程序进行吹入CO 2的压力为12毫米汞柱。有两个经验丰富的妇科医生进行妇科病例。我们所有的案件都与丙泊酚和芬太尼麻醉，插管往往促进了低剂量的罗库溴铵（15毫克）。 从我们日常的临床工作中，我们已经确定了一个最令人不安的副作用后腹腔镜子宫切除术，这是支持由文献8肩部疼痛。有研究表明，降低腹内压，也可以减少肩部疼痛。在努力减少CO 2的吹入压力，为事先关注的问题之一是，如果手术野，在手术过程中的可视性将受到损害。试图确定在手术过程中的概述，我们成立了一个方法来比较腹腔内的工作空间。但是，它可以是非常困难的监测在患者腹腔内体积的准确河畔期间盖瑞。在比利时的研究，卷压的关系已经说明，但该研究的作者得出的结论是有很大的个体间的变化9。为了获得更可靠的语句腹腔内的空间，我们使用海角的距离度量的皮肤。

deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy

肩部疼痛是一种常见的症状，如子宫肌瘤剔除术或子宫切除术腹腔镜手术后，最近的研究表明，在手术过程中可能会降低充气压力减少的风险，手术后的疼痛。在这个试验性研究中，提出了一种方法，用于测量的腹腔内给外科医生在测定法laproscopy过程中的可用空间，以检查是否松弛产生的深部神经肌肉阻滞作用，可以增加工作的手术空间足以允许在CO 2的减少充气压力。使用腹腔镜抓手，皮肤海角的距离的测量是在两个不同的注气压力：8毫米汞柱和12毫米汞柱。初步测量后，神经肌肉阻断剂（罗库溴铵）向患者给药，腹腔内的体积再次测量。 15例患者收集到的导频数据表明，腹腔内的空间在8毫米汞柱与BLO与腹腔内的空间在12毫米汞柱，无封锁计量ckade。不与患者的身高，体重，BMI，年龄的影响神经肌肉阻滞。因此，使用神经肌肉阻滞作用，保持一个稳定的音量，同时降低充气压力，可能会产生改善患者预后。

这项试验研究的15例患者进行了腹腔镜手术过程中的深部神经肌肉阻滞的影响进行评估。 这里说明的方法是用于获取在腹腔镜全子宫切除术（ 图1）的患者的腹腔内空间的测量。在每一个病人，测量腹腔内空间下采取了以下条件：12毫米汞柱压力，而深部神经肌肉阻滞，12毫米汞柱，封锁不封锁，8毫米汞柱，和8毫米汞柱封锁。 在这两个12毫米?...

Watch this Scientific Journal Video about Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy at JoVE.com

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

本文提出了一种方法测量工作期间卷腹腹腔镜子宫肌瘤剔除术的手术抓手，并应用这种技术来取得的试验数据，深神经肌肉阻滞（NMB）是否可以允许使用较低的充气压力。在腹腔镜手术中气腹压力减少已经证明，以减少手术后的疼痛，因此在手术过程中就使用NMB可能使改善患者的治疗效果。

深神经肌肉阻滞信息到更大的在腹腔镜腹腔容积

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that ...

Research

JoVE Journal

Medicine

Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources:  A Computational Model

背柱与双并行使用专用电源的信息Steerability，计算模型

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic ...

科研

医学

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

利用经颅磁刺激，以研究人类的神经肌肉系统

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

A Murine Model of Muscle Training by Neuromuscular Electrical Stimulation

一个小鼠模型，通过神经肌肉电刺激肌肉训练

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional ...

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

蒸汽腔体建设用于公开小鼠酒精在所有三个学期人类发展的等效

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

时空步态参数的患者和老年人的临床评估

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Busulfan as a Myelosuppressive Agent for Generating Stable High-level Bone Marrow Chimerism in Mice

白消安作为骨髓抑制剂在小鼠生成稳定的高水平骨髓嵌合体

Bone marrow transplantation (BMT) is often used to replace the bone marrow (BM) compartment of recipient mice with BM cells expressing a distinct ...

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

深静脉血栓形成的评价和定量的多中心MRI协议

We evaluated a magnetic resonance venography (MRV) approach with gadofosveset to quantify total thrombus volume changes as the principal criterion for ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

使用Saccadometry与深部脑刺激来研究正常和病理脑功能

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

肺毛细血管血量，膜弥散能力，及肺内动静脉吻合的评估期间行使

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

皮下三瓣阀修复期间回声导的简化步进方法

Percutaneous transcatheter edge-to-edge reconstruction of the mitral valve is a safe and well-established therapy for severe symptomatic mitral ...