Background: The aim of this study was to evaluate the effect of deep and moderate neuromuscular block on surgical exposure quality, intraoperative lung mechanics, and postoperative respiratory functions, during laparoscopic bariatric surgery. Methods: Sixty adult morbid obese patients were enrolled in the study. They were randomly distributed in two equal groups: the deep block group, where rocuronium infusion was given to maintain the post-tetanic counts above 1, and the moderate block group, where increments of rocuronium were delivered to maintain the train of four 1-2. The surgeon was asked to assess intraoperative relaxation. The increase in intra-abdominal pressure and reported abdominal or diaphragmatic movements were recorded. Intraoperative lung mechanics were studied, and preoperative and postoperative pulmonary function tests were done. Results: The scores reported by the surgeons for intraoperative surgical exposure were indifferent among the two groups (5 (4-5) in the deep block group and 4 (3-5) in the moderate block group, P = 0.243). The difference in the increase in intra-abdominal pressure and reported abdominal or diaphragmatic movements was insignificant between both (P = 0.299 and 0.424). Intraoperative pulmonary mechanics and postoperative pulmonary functions were comparable (P > 0.05), and the postoperative pain score was indifferent between both groups (P > 0.05). Conclusion: During laparoscopic bariatric surgery of morbidly obese patients, the quality of abdominal relaxation and surgical exposure, intraoperative lung mechanics, and postoperative pulmonary functions were indifferent with the use of moderate or deep neuromuscular block.

Background: This trial aimed to evaluate the effect of the use of triple the ED 95 of rocuronium and vecuronium on the onset of relaxation and the intubation score in morbidly obese patients. Methods: Sixty adult morbidly obese patients were included in this trial and were randomly assigned according to the muscle relaxants used to the ROC group, in which patients received rocuronium (0.9 mg/kg), and VEC group, in which the patients received vecuronium (0.15 mg/ kg). The onset and duration of relaxation, the time of intubation, and the intubation scores were assessed. Additionally, the response of hemodynamic parameters to the injection of muscle relaxants and to the intubation was recorded. Results: The onset of relaxation was significantly lower in ROC group (57.5 ± 19.9 sec) than in VEC group (105.0 ± 18.8 sec) (P < 0.0001). Additionally, the time for intubation was significantly shorter in ROC group (69.00 ± 19.4 sec) than in VEC group (120.8 ± 17.7 sec) (P < 0.0001). Moreover, there was a significant increase in the duration of relaxation in ROC group (85.5 ± 19.2 min) compared with VEC group (72.00 ± 22.65 min) (P = 0.016). However, there was no significant difference between the two groups in the intubation score (P = 0.656) and the changes in the hemodynamic parameters (P > 0.05). Conclusion:The use of triple the ED 95 of rocuronium in morbidly obese patients significantly shortened the onset of relaxation and the timing of intubation compared to vecuronium. However, the intubation score and the hemodynamic changes during intubation were comparable.