Association between Absence of Detectable Intraoperative Train-of-Four Response and Operative Time During Laparoscopic Cholecystectomy under Conventional-Pressure Pneumoperitoneum: A Retrospective Cohort Study
Hyun-Seong Lee, Daeseok Oh, Ji Yeon Kwon, Byeongcheol Lee, Junseong Moon, Myungjin KoAbstract
Background:
Protocol-defined deep neuromuscular blockade may improve surgical conditions during laparoscopy; however, its association with clinical outcomes under conventional-pressure pneumoperitoneum remains uncertain.
Objectives:
This study evaluated the association between intraoperative train-of-four (TOF) response patterns and perioperative outcomes in patients undergoing laparoscopic cholecystectomy under 15 mm Hg pneumoperitoneum.
Materials and Methods:
We retrospectively reviewed 226 patients who underwent laparoscopic cholecystectomy in 2024 under conventional-pressure pneumoperitoneum. According to intraoperative TOF monitoring, patients were classified into the maximum recorded intraoperative TOF count (TOFmax) = 0 group (TOF count = 0 at all recorded intraoperative time points) or the TOFmax ≥1 group (any recorded TOF count ≥1). The primary outcome was operative time, and secondary outcomes included anesthesia time, early postoperative pain outcomes, and adverse events.
Results:
Of 226 patients, 71 (31.4%) were in the TOFmax = 0 group, and 155 (68.6%) were in the TOFmax ≥1 group. Operative time was shorter in the TOFmax = 0 group (median 30 vs. 40 min,
Conclusion:
In this retrospective cohort, absence of detectable intraoperative TOF response at all recorded time points was associated with shorter operative time during laparoscopic cholecystectomy under conventional-pressure pneumoperitoneum. However, this observational association does not establish causality and warrants prospective validation.