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  • Deep neuromuscular block improves angiographic image quality during endovascular coiling of unruptured cerebral aneurysm: a randomized clinical trial

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Neuroimaging
Original research
Deep neuromuscular block improves angiographic image quality during endovascular coiling of unruptured cerebral aneurysm: a randomized clinical trial
  1. Bo Young Kim1,
  2. Sung Hoon Chung2,
  3. Seong-Joo Park2,
  4. Sung-Hee Han2,
  5. O-Ki Kwon3,
  6. Jun-Young Chung4,
  7. Jin-Hee Kim2
  1. 1 Graduate School, Department of Medicine, Kyung Hee University, Seoul, Republic of Korea
  2. 2 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  3. 3 Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  4. 4 Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
  1. Correspondence to Professor Jin-Hee Kim, Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; anesing1{at}snu.ac.kr

Abstract

Background Neuromuscular block (NMB) used during general anesthesia induces transient skeletal muscle paralysis, but patient movements during endovascular coiling still occur to some degree. Compared with moderate NMB, deep NMB may further improve the intervention condition during endovascular coiling for unruptured cerebral aneurysms; however, little research has focused on the angiographic image quality.

Methods This prospective, randomized, double-blind clinical trial included 58 patients treated for unruptured cerebral aneurysms with endovascular coiling under general anesthesia. Patients were randomly allocated to either the deep NMB group (post-tetanic count 1 or 2) or the moderate NMB group (train-of-four 1 or 2). The primary outcome was the proportion of patients with a satisfactory intervention condition assessed by surgeons after the procedure using a 5-point intervention condition rating scale (ICRS) from 1 (unable to obtain image) to 5 (optimal); ICRS 5 was defined as satisfactory.

Results There were significantly more cases of satisfactory intervention condition in the deep NMB group than in the moderate NMB group (82.1% vs 51.7%, p=0.015). The frequency of each ICRS score was significantly different between the groups (ICRS 5/4/3/2/1: 23/5/0/0/0 vs 15/9/2/3/0, p=0.035). The incidence of major patient movement requiring rescue muscle relaxant was 10.3% in the moderate NMB group and 0% in the deep NMB group (p=0.237). The drugs used to maintain hemodynamic stability were not significantly different between the two groups.

Conclusions Deep NMB improves the intervention condition during endovascular coiling by improving the image quality.

  • aneurysm
  • angiography
  • coil
  • complication
  • intervention

https://doi.org/10.1136/neurintsurg-2020-015947

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    Footnotes

    • Correction notice Since the online publication of this article, the authors noticed that 'Jun-Young Chung' was incorrectly spelt as 'Jun-Young Jung'. This has been corrected.

    • Contributors Concept and design: BYK, J-YJ, O-KK, J-HK. Acquisition of data: BYK, SHC, S-JP. Analysis of data: All authors. Drafting of the manuscript: BYK. Critical revision of the manuscript: S-HH, O-KK, J-YJ, J-HK. Supervision: J-HK. All authors approved the final version to be published and agree to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Institutional Review Board of the Seoul National University Bundang Hospital (ref: B-1805-468-004).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request to the corresponding author.