Effect of depth of neuromuscular blockade on the abdominal space during pneumoperitoneum establishment in laparoscopic surgery

Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis

“…Distance from sacral promontory to skin The studies of Barrio and colleagues, 4 Lindekaer and colleagues, 18 and Madsen and colleagues, 19 quantified the surgical space conditions by measuring the distance from the sacral promontory to the skin. All three studies concluded that deep NMB increased the promontory-to-skin distance in a significant manner; 0.48, 1.57, and 0.33 cm, respectively, at an insufflation pressure of 1.6 kPa (12 mm Hg).…”

“…The studies of Blobner and colleagues, 16 Dubois and colleagues, 14 Martini and colleagues, 20 and Torensma and colleagues 15 used a stable standard pressure level of pneumoperitoneum in both groups. The papers of Barrio and colleagues, 4 Lindekaer and colleagues, 18 and Madsen and colleagues, 19 corresponding 95% confidence intervals (95% CI). adverse events were reported by Blobner and colleagues 16 and Staehr Rye and colleagues.…”

“…patients' obesity, previous pregnancies, or previous abdominal surgery) and by modifiable factors, such as anaesthesia-related factors, IAP, and body position. 4 Several trials have been performed showing that deep neuromuscular block (NMB) improves surgical conditions in different types of laparoscopic procedures. 1 5 6 The depth of NMB is assessed mostly by acceleromyography, also known as train-of-four (TOF) monitoring.…”

“…Forest plot of studies comparing surgical space conditions during laparoscopic procedures with deep NMB vs moderate, shallow, or no NMB. The effect size is calculated as the mean difference in surgical rating score (range[1][2][3][4][5] and corresponding 95% confidence intervals (95% CI). The duration of surgery is not significantly decreased by the use of deep NMB.…”

Robot-Assisted Robotic Prostatectomy in a Patient with Dilated Cardiomyopathy and LVEF of 35%

“…To maintain a pneumoperitoneum as light as possible we obtained an extreme muscular relaxation with rocuronium bromide on demand, administering muscle relaxant as the TOF marked us 2 of four in this way thanks to the trendelembur position of 20º and extreme relaxation we managed to perform the Intervention with pressures in the pneumoperitoneum of 9-10 mmHg [8]. The very low pneumoperitoneum pressure helps to improve the filling of the right atrium, it helps the contractility of the left ventricle and improve the cardiac function and also decressing peripheral resistances.…”