Reducing Remifentanil Usage in Laparoscopic Rectal Cancer Surgery for Elderly Patients by Optimizing Dosing.

BACKGROUND: Colorectal cancer is a prevalent and serious health concern globally, particularly among the elderly population. Laparoscopic surgery is a commonly used approach for colorectal cancer treatment. However, the use of appropriate anesthesia and muscle relaxants is essential to ensure optimal surgical outcomes. Elderly patients undergoing surgery often have unique physiological characteristics and comorbidities, such as hypertension, diabetes, and coronary heart disease. These factors can affect treatment efficiency and patient outcomes.

OBJECTIVE: This study aimed to investigate the impact of different target-controlled infusion concentrations of rocuronium bromide on elderly patients undergoing laparoscopic colorectal cancer surgery.

METHODS: This is a prospective randomized controlled study. Ninety senior adults who underwent laparoscopic colorectal cancer surgery at our hospital between September 2018 and May 2020 were selected as the eligible participants. They were randomly divided into three groups: the low-dose group (0.6 mg/L of rocuronium bromide), the middle-dose group (0.9 mg/L of rocuronium bromide), and the high-dose group (1.2 mg/L of rocuronium bromide). The purpose of this division was to administer target-controlled infusions of rocuronium bromide to maintain skeletal muscle relaxation during the surgical procedure. Data on various outcome measures, including skeletal muscle relaxation effectiveness, patient satisfaction, skeletal muscle relaxation recovery times and indices, extubation duration, and remifentanil dosage, were collected and analyzed.

RESULTS: The middle-dose group and the high-dose group exhibited notably higher levels of satisfaction with skeletal muscle relaxation compared to the low-dose group. As the rocuronium bromide dosage increased, the patients experienced prolonged recovery times and had higher skeletal muscle indices (P < .05). Additionally, the middle-dose group demonstrated significantly reduced extubation times and lower remifentanil dosages compared to the other groups (P < .05). The enhanced satisfaction levels in the middle-dose and high-dose groups, indicating that higher concentrations of rocuronium bromide may be more effective in achieving optimal skeletal muscle relaxation during laparoscopic colorectal cancer surgery. The prolonged recovery times and higher skeletal muscle indices associated with increased dosage suggest a dose-dependent effect on muscle relaxation.

CONCLUSION: For elderly patients undergoing laparoscopic rectal cancer surgery, the use of a target-controlled infusion of 0.9 mg/L of rocuronium bromide appears to be a viable option. It maintains adequate skeletal muscle relaxation, shortens postoperative recovery time, and reduces the demand for remifentanil, demonstrating excellent potential for clinical application. These findings provide valuable insights for anesthesiologists and healthcare professionals involved in the perioperative management of elderly patients undergoing laparoscopic rectal cancer surgery. Implementing the optimized dosage of rocuronium bromide can contribute to enhanced surgical outcomes, improved patient satisfaction, and more efficient resource utilization in the clinical setting.