Deep Neuromuscular Block With Pipecuronium in Patients Undergoing Robotic Thoracic Surgery

In the researchers' words

Robotic-assisted surgery is rapidly expanding across surgical specialties, including thoracic surgery. Compared with conventional techniques, robotic surgery provides the surgeon with a three-dimensional view and highly precise instrument movement with a 360-degree range of motion. These advantages, however, also place particular emphasis on maintaining complete patient immobility throughout the procedure, as involuntary movement may result in serious injury caused by the robotic instruments. Neuromuscular blockade is therefore an essential component of anesthesia for robot-assisted thoracic surgery. Deep neuromuscular blockade provides profound relaxation of the diaphragm and chest wall muscles, thereby minimizing patient movement and creating optimal surgical conditions. At the same time, prolonged and profound neuromuscular blockade requires accurate quantitative monitoring and reliable pharmacological reversal to ensure safe recovery and facilitate enhanced recovery after surgery (ERAS). Pipecuronium bromide (Arduan®) is a Hungarian-developed, long-acting aminosteroid neuromuscular blocking agent with a duration of approximately 45-100 minutes. It has minimal cardiovascular effects, does not induce histamine release, and is eliminated predominantly through the liver and, to a lesser extent, the kidneys. These pharmacological characteristics make pipecuronium potentially…