Clinical Impact of Deep Versus Moderate Neuromuscular Block for Bariatric Surgery: A Systematic Review and Meta-analysis
[1]
Lucas Ferreira Gomes Pereira, University Centre of Volta Redonda - UniFOA, Volta Redonda, Rio de Janeiro, Brazil.
[2]
Regina El Dib, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada; Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP – São Paulo State University, São Paulo, São José dos Campos, Brazil; McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada.
[3]
Carlos Darcy Alves Bersot, Department of Anesthesiology, Lagoa Federal Hospital, Rio de Janeiro, Brazil.
[4]
José Eduardo Guimarães Pereira, Department of Anesthesiology, Botucatu Medical School, UNESP – São Paulo State University, São Paulo, Brazil; Department of Anesthesiology, EsSEx, Army Central Hospital, Rio de Janeiro, RJ, Brazil; Department of Anesthesiology, Barra Mansa Wholy House of Mercy Hospital, Barra Mansa, Rio de Janeiro, Brazil.
This systematic review and meta-analysis were designed to investigate the efficacy and safety of deep (DNMB) versus moderate (MNMB) neuromuscular block on the treatment of patients submitted to bariatric surgery. Randomized controlled trials (RCTs) were searched from inception to December 2017 in the following databases: PubMed, EMBASE, COCHRANE, Scopus, Web of Science and LILACS. Reviewers independently screened potentially eligible articles, extracted data from included studies and assessed their risk of bias. We used the GRADE approach to rate overall certainty of the evidence for each outcome. Two RCTs including 160 participants proved eligible, and their results yielded a statistically significant improvement on surgical field quality according to the Leiden-Surgical Rating Scale (L-SRS) with the use of DNMB compared to MNMB (MD 0.57, 95% CI 0.39 to 0.75; participants = 160; studies = 2; I2 = 16%; p < 0.00001). Results from one RCT yielded a statistically significant reduction in pain scores at the post-anesthesia care unit (MD -0.50, 95% CI -0.71 to -0.29; participants = 100; studies = 1; p < 0.00001) and in referred shoulder pain at the surgical ward (MD -0.50, 95% CI -0.64 to -0.36; participants = 100; studies = 1; p < 0.00001) with the use of DNMB compared to MNMB. There was no increase in adverse outcomes detected. The quality of evidence was rated as very-low for both outcomes.
Anesthesia, Neuromuscular Blocking, Bariatric Surgery, Deep Neuromuscular Block, Moderate Neuromuscular Block
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