Prospective Randomized Trial of Moderate vs Deep Neuromuscular Blockade During Laparoscopic Ventral Hernia Repair
Hernia, Ventral, Neuromuscular Blockade, Pneumoperitoneum
About this trial
This is an interventional treatment trial for Hernia, Ventral
Eligibility Criteria
Inclusion Criteria:
- Patients age 18-75 years old
- Umbilical, ventral, epigastric, spigelian or incisional hernia
- Plan for laparoscopic ventral hernia repair with mesh
- Estimated fascial defect between 2-10 cm in maximum diameter
Exclusion Criteria:
- Allergy to medications delineated in the protocol (muscle blockade, anesthetics, reversal agents)
- Inability to provide informed consent
- Body mass index of 35 or over
- Multiple recurrent hernias (>1)
- Creatinine clearance < 30 ml/min (using the Cockcroft-Gault calculation)
Sites / Locations
- Shabana HumayonRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Moderate Neuromuscular Block
Deep Neuromuscular Block
Train of four count of 1-2. All procedures will start with low-pressure insufflation (8 mm Hg). Surgeon assessment of the conditions will be serially performed during surgery on an established visual scale. If conditions are deemed less than adequate (score 1-2), insufflation pressure will incrementally increase up to 15 mm Hg. Reversal of muscle relaxation will be performed at the end of the procedure using established medications used in clinical practice. In theory, deep relaxation may require a more prolonged reversal process, but using contemporary medical agents (sugammadex), reversal from deep relaxation is prompt (2-3 minutes) without any additional delays.
Post tetanic count of 1-2. All procedures will start with low-pressure insufflation (8 mm Hg). Surgeon assessment of the conditions will be serially performed during surgery on an established visual scale. If conditions are deemed less than adequate (score 1-2), insufflation pressure will incrementally increase up to 15 mm Hg. Reversal of muscle relaxation will be performed at the end of the procedure using established medications used in clinical practice. In theory, deep relaxation may require a more prolonged reversal process, but using contemporary medical agents (sugammadex), reversal from deep relaxation is prompt (2-3 minutes) without any additional delays.