Stomach Cancer
Conditions
Keywords
deep neuromuscular block, robot-assisted surgery, stress response, stomach cancer
Brief summary
Stress reactions caused by surgical stimuli can cause sympathetic nervous system activation and increased stress hormones, such as catecholamines, inflammatory cytokines, and pituitary hormones, and insulin resistance. In addition, increased catecholamine levels may exacerbate postoperative outcomes, especially delayed wound recovery, increased cardiovascular and respiratory complications, and immunosuppression. In particular, it is important to reduce the stress response for cancer patients during surgery because they are already immunocompromised status and more vulnerable to perioperative stressful situation. However, there are insufficient results on the benefits of deep neuromuscular block in these patients, although some have reported a reduction of postoperative pain and fewer complications in the deep neuromuscular block compared with moderate neuromuscular block. Therefore, the investigators aim to investigate the difference in the stress response of patients who received conventional moderate neuromuscular block or deep neuromuscular block in robot-assisted gastric cancer surgery.
Interventions
DRUGModerate neuromuscular block with 'rocunium®'
Rocuronium will be maintained in a arm 1) deep neuromuscular block group or arm 2) moderate neuromuscular block group (control group) according to the assignment. The degree of muscle relaxation is determined by 1 to 2 for train-of-four (TOF) in moderate neuromuscular group.
DRUGDeep neuromuscular block with 'rocunium®'
Rocuronium will be maintained in a arm 1) deep neuromuscular block group or arm 2) moderate neuromuscular block group (control group) according to the assignment. The degree of muscle relaxation is determined by 1 to 2 for post-tetanic count (PTC) in deep neuromuscular group.
Sponsors
Yonsei University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* 1\. ASA Ⅰ - Ⅱ patients between 20 and 65 years undergoing robot-assisted gastric cancer surgery
Exclusion criteria
* 1\. Patients with neuromuscular disease * 2\. Hypertensive patients with β-blockers * 3\. Diabetic patients receiving insulin therapy * 4\. Patients with severe heart (EF \<45%), kidney (GFR \<60), liver dysfunction (ALT / AST\> 100) * 5\. Patients with obesity (BMI ≥30) * 6\. Do not understand Korean language * 7\. For vulnerable subjects who are unable to obtain consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference of stress responses between deep block and moderate block | at baseline (T1) | Comparison of perioperative stress responses with biomarkers including cortisol, interleukin-6, natural killer cell and HRV between deep neuromuscular block group and moderate neuromuscular group |
Countries
South Korea
Outcome results
None listed