Gynaecologic laparoscopy with or without muscle relaxants.

Objective: To assess physiological changes and operating conditions during general anaesthesia with or without neuromuscular blockade in patients undergoing gynaecologic laparoscopy. Study design: Prospective, randomized, double-blind study. Patients: Fifty non-obese patients, mean age 31 years, randomly allocated into either a group of 25 with curare (AC) or a group of 25 without curare (SC). Methods: All patients were anaesthetized with propofol (2.5 mg . kg(-1)), sufentanil (0.4 mu g . kg(-1)) midazolam (2 mg) and N2O-O-2. In addition, those of the AC group were given atracurium 0.25 mg . kg(-1) for intubation, followed by additional boluses to maintain twitch height < 10% of the control value. Blood pressure, heart rate, peak airway pressure, end-tidal carbon dioxide pressure were recorded before and during pneumoperitoneum maintained al a pressure of 15 mmHg. Operating conditions were assessed at 10-min intervals, using a four-point scale. Results: in both groups, blood pressure and heart rate decreased following induction. The decrease in blood pressure was more important in the SC group at 5 min and before pneumoperitoneum (25 vs 15%; P < 0.05). The time course of PETCO(2) and peak airway pressures were similar between groups, Operating conditions were not influenced by the muscle relaxant. Conclusions: Neuromuscular blockade influences neither most of the clinical haemodynamic and respiratory changes induced by pneumoperitoneum for gynaecologic laparoscopy nor the operating conditions.