title: Optimizing working space in laparoscopy: CT-measurement of the effect of neuromuscular blockade and its reversal in a porcine model.
abstract: OBJECTIVE
  The objective of this paper was to determine the effect of neuromuscular blockade (NMB) on working space in a porcine laparoscopy model.
  
  
  BACKGROUND
  Conflicting results on the effect of NMB on laparoscopic working space are found in literature. Almost all studies are limited by absence of objective assessment of working space or use surrogate outcomes.
  
  
  METHODS
  In a standardized porcine laparoscopy model, laparoscopic working-space dimensions with and without NMB were investigated in 16 animals using computed tomography at intra-abdominal pressures of 0, 5, 10, and 15 mmHg during multiple runs of abdominal insufflation.
  
  
  RESULTS
  No statistically significant effect of NMB on abdominal dimensions and laparoscopic working-space volume was found during CO2 pneumoperitoneum. In contrast, the effect of pre-stretching of the abdominal wall by a previous abdominal insufflation was found to be significant.
  
  
  CONCLUSIONS
  This experimental study confirms the results from several clinical studies that NMB does not influence laparoscopic working space. Studies dealing with working space during laparoscopy should take note of pre-stretching bias.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC: University Medical Center, P.O Box 2060, 3000 CB, Rotterdam, The Netherlands, john.vlot@erasmusmc.nl.
authors.forename: John
authors.initials: J
authors.lastname: Vlot
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Specht
authors.forename: René M H
authors.initials: RM
authors.lastname: Wijnen
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.forename: Egbert G
authors.initials: EG
authors.lastname: Mik
authors.forename: Klaas M A
authors.initials: KM
authors.lastname: Bax
mesh_terms: D034841:Abdominal Cavity / Q000000981:diagnostic imaging*; D000732:Androstanols / Q000494:pharmacology; D000818:Animals; D002245:Carbon Dioxide; D007327:Insufflation; D010535:Laparoscopy; D023421:Models, Animal; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology; D011028:Pneumoperitoneum, Artificial; D000077123:Rocuronium; D000077122:Sugammadex; D013552:Swine; D014057:Tomography, X-Ray Computed; D047408:gamma-Cyclodextrins / Q000494:pharmacology
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D002245:Carbon Dioxide; D000077122:Sugammadex; D000077123:Rocuronium