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Eur J Pediatr Surg 2017; 27(03): 263-268
DOI: 10.1055/s-0036-1587329
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Is Neuromuscular Blocker Necessary in Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing?

Ali Ahiskalioglu
1   Department of Anesthesiology and Reanimation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
,
İlker İnce
1   Department of Anesthesiology and Reanimation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
,
Elif Oral Ahiskalioglu
2   Department of Anaesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
,
Akgun Oral
3   Department of Pediatric Surgery, Atatürk University, Erzurum, Turkey
,
Mehmet Aksoy
1   Department of Anesthesiology and Reanimation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
,
Murat Yiğiter
3   Department of Pediatric Surgery, Atatürk University, Erzurum, Turkey
,
Mehmet Emin Celikkaya
3   Department of Pediatric Surgery, Atatürk University, Erzurum, Turkey
,
Ahmet Bedii Salman
3   Department of Pediatric Surgery, Atatürk University, Erzurum, Turkey
› Author Affiliations
Further Information

Publication History

06 April 2016

07 July 2016

Publication Date:
22 August 2016 (online)

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Abstract

Purpose The aim of this study is to evaluate operating conditions during general anesthesia with or without neuromuscular blocker (NMB) in patients undergoing percutaneous internal ring suturing (PIRS).

Materials and Methods In this study, 40 patients, with American Society of Anesthesiologists I and II between the ages of 1 and 12 years, were randomly assigned to two groups to receive muscle relaxant with endotracheal tube (ETT) (ETT group) or without muscle relaxant with supreme laryngeal mask airway (sLMA) (LMA group). Anesthesia was maintained with sevoflurane in oxygen (Fio 2 0.3–0.5), thiopental sodium, fentanyl, and rocuronium in ETT group. In LMA group, same protocol was used without rocuronium. Heart rate, blood pressure, peak airway pressure, end-tidal carbon dioxide (EtCO2), and Spo 2 were recorded before and during pneumoperitoneum maintained at a pressure of 8 to 10 mm Hg. Duration of surgery, recovery time, anesthetic time, and grade of quality view were also recorded. Airway problems (cough, hoarseness, laryngospasm, and aspiration) were recorded.

Results In LMA group, there was a statistically significant reduction in recovery time versus ETT group (11.6 ± 4.08 vs. 17.15 ± 5.32 minutes; p = 0,001). There were no statistically significant differences grade of quality view between the two groups (p = 0.548). There were no statistically significant differences in oxygen saturation (Spo 2), peak airway pressure, and EtCO2 between the two groups before or during insufflation (p > 0.05). Postoperative airway complications were significantly more prevalent in the ETT group. There was no case of inadequate ventilation, regurgitation, or aspiration recorded.

Conclusion sLMA is safe and suitable alternative to ETT and NMB is not necessary in general anesthesia with sLMA, pediatric patients undergoing laparoscopic hernia repair with PIRS.

Keywords

percutaneous internal ring suturing - inguinal hernia repair - neuromuscular blocker - supreme laryngeal mask airway - endotracheal tube
 

  • References

  • 1 Wang KS. ; Committee on Fetus and Newborn, American Academy of Pediatrics; Section on Surgery, American Academy of Pediatrics. Assessment and management of inguinal hernia in infants. Pediatrics 2012; 130 (04) 768-773
    CrossrefPubMedGoogle Scholar
  • 2 Kelly KB, Ponsky TA. Pediatric abdominal wall defects. Surg Clin North Am 2013; 93 (05) 1255-1267
    CrossrefPubMedGoogle Scholar
  • 3 Palmer LS. Hernias and hydroceles. Pediatr Rev 2013; 34 (10) 457-464 , quiz 464
    CrossrefPubMedGoogle Scholar
  • 4 Zani A, Eaton S, Hoellwarth M. , et al. Management of pediatric inguinal hernias in the era of laparoscopy: results of an international survey. Eur J Pediatr Surg 2014; 24 (01) 9-13
    PubMedGoogle Scholar
  • 5 Wolak PK, Patkowski D. Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique - own experience. Wideochir Inne Tech Maloinwazyjne 2014; 9 (01) 53-58
    PubMedGoogle Scholar
  • 6 Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W. Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A 2006; 16 (05) 513-517
    CrossrefPubMedGoogle Scholar
  • 7 Aydogmus MT, Turk HS, Oba S, Unsal O, Sinikoglu SN. Can Supreme™ laryngeal mask airway be an alternative to endotracheal intubation in laparoscopic surgery?. Braz J Anesthesiol 2014; 64 (01) 66-70
    PubMedGoogle Scholar
  • 8 Williams MT, Rice I, Ewen SP, Elliott SM. A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy. Anaesthesia 2003; 58 (06) 574-578
    CrossrefPubMedGoogle Scholar
  • 9 Chen BZ, Tan L, Zhang L, Shang YC. Is muscle relaxant necessary in patients undergoing laparoscopic gynecological surgery with a ProSeal LMA™?. J Clin Anesth 2013; 25 (01) 32-35
    CrossrefPubMedGoogle Scholar
  • 10 Abdi W, Amathieu R, Adhoum A. , et al. Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA supreme and the ETT. Acta Anaesthesiol Scand 2010; 54 (02) 141-146
    CrossrefPubMedGoogle Scholar
  • 11 Maltby JR, Beriault MT, Watson NC, Liepert D, Fick GH. The LMA-ProSeal is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anaesth 2002; 49 (08) 857-862
    CrossrefPubMedGoogle Scholar
  • 12 Sinha A, Sharma B, Sood J. ProSeal as an alternative to endotracheal intubation in pediatric laparoscopy. Paediatr Anaesth 2007; 17 (04) 327-332
    CrossrefPubMedGoogle Scholar
  • 13 Butterworth J, Mackey DC, Wasnick J. Morgan and Mikhail's Clinical Anesthesiology. 5th ed. New York: McGraw-Hill Education; 2013: 321
    Google Scholar
  • 14 Lenth RV. Some practical guidelines for effective sample size determination. Am Stat 2001; 55: 187-193
    CrossrefPubMedGoogle Scholar
  • 15 Feng S, Zhao L, Liao Z, Chen X. Open versus laparoscopic inguinal herniotomy in children: a systematic review and meta-analysis focusing on postoperative complications. Surg Laparosc Endosc Percutan Tech 2015; 25 (04) 275-280
    CrossrefPubMedGoogle Scholar
  • 16 Cui Z, Liu Y, Zhang W, Sun F. Single-port laparoscopic percutaneous double ligation for pediatric inguinal hernias: report of a new technique and early results. Hernia 2015
    PubMedGoogle Scholar
  • 17 van Zundert TC, Brimacombe JR, Ferson DZ, Bacon DR, Wilkinson DJ. Archie Brain: celebrating 30 years of development in laryngeal mask airways. Anaesthesia 2012; 67 (12) 1375-1385
    CrossrefPubMedGoogle Scholar
  • 18 Thomas DT, Göcmen KB, Tulgar S, Boga I. Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: experience with 250 cases. J Pediatr Surg 2015
    PubMedGoogle Scholar
  • 19 Maltby JR, Beriault MT, Watson NC, Fick GH. Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-Classic vs. tracheal intubation. Can J Anaesth 2000; 47 (07) 622-626
    CrossrefPubMedGoogle Scholar
  • 20 Saraswat N, Kumar A, Mishra A, Gupta A, Saurabh G, Srivastava U. The comparison of ProSeal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia. Indian J Anaesth 2011; 55 (02) 129-134
    CrossrefPubMedGoogle Scholar
  • 21 Ozdamar D, Güvenç BH, Toker K, Solak M, Ekingen G. Comparison of the effect of LMA and ETT on ventilation and intragastric pressure in pediatric laparoscopic procedures. Minerva Anestesiol 2010; 76 (08) 592-599
    PubMedGoogle Scholar
  • 22 Mironov PI, Estekhin AM, Mirasov AA. [Anaesthetic maintenance with laryngeal mask for a laparoscopic surgery in pediatric patients]. Anesteziol Reanimatol 2013; (01) 10-14
    PubMedGoogle Scholar
  • 23 Chassard D, Bryssine B, Golfier F, Raupp C, Raudrant D, Boulétreau P. [Gynecologic laparoscopy with or without curare]. Ann Fr Anesth Reanim 1996; 15 (07) 1013-1017
    CrossrefPubMedGoogle Scholar
  • 24 Radu AD, Miled F, Marret E, Vigneau A, Bonnet F. Pharyngo-laryngeal discomfort after breast surgery: comparison between orotracheal intubation and laryngeal mask. Breast 2008; 17 (04) 407-411
    CrossrefPubMedGoogle Scholar
  • 25 Hanley ES. Anesthesia for laparoscopic surgery. Surg Clin North Am 1992; 72 (05) 1013-1019
    CrossrefPubMedGoogle Scholar
  • 26 Greif R, Theiler L. The use of supraglottic airway devices in pediatric laparoscopic surgery. Minerva Anestesiol 2010; 76 (08) 575-576
    PubMedGoogle Scholar