A prospective observational study to compare neuromuscular blockade recovery time with Train of Four after extubation when Atracurium is used as muscle relaxant In Laparoscopic versus open abdominal surgery

After obtaining approval from institutional ethical committee and written informed consent from all 54 patients as per sample size,  fulfilling the inclusion criteria, thorough pre-operative evaluation will be done. All the patients will be divided into two groups- GROUP A (Laparoscopic abdominal surgery) and GROUP B (Open abdominal surgery).

General Anaesthesia management for both the groups will be done according to the standard protocol including- Inj. Midazolam 0.05mg/kg, Inj. Fentanyl 2mcg/kg for premedication and sedation, Inj. Propofol 2mg/kg for induction. Intubation will be done under the effect of bolus dose of Inj. Atracurium 0.5mg/kg and maintenance will be done with O2, Air and Sevoflurane 1-3% with MAC of 0.8-0.9 using closed circuit. Intermittent dose of Inj. Atracurium 5mg as per the requirement will be given and total quantity will be noted.

Intra-operative vital parameters monitoring will be done including Pulse rate (PR), Blood pressure (BP), Oxygen saturation (SpO2), End-tidal carbon dioxide (ETCO2). Time of Reversal of NM Blockade will be decided by the anaesthesiologist after appearance of 1st Curare notch and extubation will be done. The time interval from last dose of Inj. Atracurium to the appearance of 1st Curare notch will be noted and ABG sample will be sent.

Then the time of completion of reversal and extubation will be noted accordingly. Quantitative assessment of recovery of NM Blockade will be confirmed with TOF Reading immediately after extubation. Patient will be monitored further in post operative care unit. To avoid confounding factors like effect of inhalational agent on muscle relaxation, concentration of sevoflurane will be monitored till the end of surgical procedure and MAC will be Recorded.