L��szl�� Asztalos: Department of Anesthesiology and Intensive Care, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
Zolt��n Szab��-Ma��k: Department of Anesthesiology and Intensive Care, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
Mariann Berh��s: Department of Anesthesiology and Intensive Care, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
Zsolt Kany��ri: Department of Surgery, University of Debrecen, Faculty of Medicine, Hungary.
Gy��rgy Nagy: Department of Anesthesiology and Intensive Care, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
Adrienn Pongr��cz: Department of Anesthesiology and Intensive Care, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
R��ka Nemes: Department of Anesthesiology and Intensive Care, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
Sorin J Brull: Mayo Clinic College of Medicine and Science, Jacksonville, FL, United States.
B��la F��lesdi: Department of Anesthesiology and Intensive Care, University of Debrecen, Faculty of Medicine, Debrecen, Hungary. Electronic address: fulesdi@med.unideb.hu.
INTRODUCTION: We tested the feasibility of maintaining low intraabdominal pressures during pipecuronium-induced deep block (post-tetanic count ���1, train-of-four count���=���0) in patients undergoing laparoscopic surgery. METHODS: Ten adult patients awaiting cardiac surgery or heart transplantation and requiring non-elective abdominal surgery were included. Pipecuronium bromide 0.09���mg/kg was used for muscle relaxation and maintenance of deep block. Top-up doses of pipecuronium (0.01-0.02���mg/kg) were administered when post-tetanic count was 4-8. Intraabdominal pressures were kept below 10���mmHg. Mean arterial pressure was measured intra-arterially. Surgical field view was rated on a 5-point scale (1���=���extremely poor, 5���=���optimal). RESULTS: Induction dose of 0.09���mg/kg pipecuronium had an onset time of 5.3 (2.3-6.3, 25-75% IQR)���min. Deep block was maintained for 51.2��������19.7���min. Top-up pipecuronium doses were necessary in 5 patients, 56.0��������28.1���min after the first dose. At the end of surgery, neuromuscular block was deep (post-tetanic count 0-6). Administration of 2���mg/kg of sugammadex induced recovery to train-of-four ratio ���0.9 in 3.5��������1.6���min, and to train-of-four ratio���=���1.0 in 4.3��������1.2���min. Mean intraabdominal pressure was 8.1��������1.1���mmHg during pneumoperitoneum. There was no significant change in heart rate (0.0, -2.6 to 0)���beats/min. DISCUSSION: Pipecuronium is a rational alternative when deep neuromuscular block is necessary, because of its long-acting neuromuscular blocking effect that may be antagonized quickly and safely with sugammadex. REGISTRATION: European Clinical Trials Database registration number: 2022-004114-11, Clinical Trials Database registration number: NCT06517524.
