Does Neuromuscular Blockade Affect the Assessment of Pelvic Organ Prolapse?

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Abstract

Pelvic examinations to assess pelvic organ prolapse (POP) can vary significantly by examination method and examiner; therefore, a great deal of effort has been made to standardize such examinations. Two single-center studies compared the results of a POP examination carried out intraoperatively with the preoperative assessment. Data from both studies suggest a difference between findings at the time of surgery under anesthesia and findings during a clinical examination in the office. Neither study, however, reported the specific impact of the type of anesthesia on intraoperative examination findings.

The aim of this multicenter, prospective, observational study was to determine whether anesthesia with neuromuscular blockade would alter the Pelvic Organ Prolapse Quantification (POP-Q) examination. Participants were women undergoing pelvic surgery. The POP-Q examination performed preoperatively in the office was repeated within 4 weeks in the operating room under neuromuscular blockade. The method of anesthesia was general endotracheal anesthesia, laryngeal mask airway, or spinal blockade. An Allis clamp was used during the intraoperative examination to gently apply traction until the POP-Q point being examined did not undergo any further descent. Individual POP-Q points and the International Continence Society stages were measured using a paired-sample t test. The International Continence Society stages were measured in 3 separate compartments (anterior, apical, and posterior).

Of the 153 women enrolled in the study, 76% received general endotracheal anesthesia and 21% laryngeal mask airway. The apical compartment was significantly more prolapsed in the operating room; the increase was 3 cm (odds ratio, P < 0.05). However, a comparison of the mean values demonstrated a greater mean change for all POP-Q points except total vaginal length. When stratified by the 3 compartments, the International Continence Society stages were systematically different in the operating room than in the office for all stages (P < 0.0005).

These findings suggest that neuromuscular blockade results in significantly greater increases in POP-Q examination measurements compared with those in the office, with the increase most pronounced apically.

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