Sugammadex, the Guardian of Deep Muscle Relaxation During Conventional and Robot-Assisted Laparoscopic Surgery: A Narrative Review

Abstract

High intra-abdominal pressure induced by artificial pneumoperitoneum can obviously impair respiratory and circulatory functions and has a negative effect on the prognosis of patients undergoing conventional and robot-assisted laparoscopic surgery. The application of deep neuromuscular blockade during the operation is reported to lower the intra-abdominal pressure and improve patients’ outcome. However, concern lies in the risks of postoperative residual muscular paralysis with the use of deep neuromuscular blockade. Sugammadex, a specific antagonist for aminosteroids muscle relaxants, can effectively and rapidly reverse rocuronium and vecuronium induced neuromuscular blockade of different depths. Thus, sugammadex allows the ability to safeguard the application of deep neuromuscular blockade in laparoscopic operations and helps to alleviate the adverse complications associated with pneumoperitoneum. Here, we review the application of deep neuromuscular blockade in different laparoscopic surgeries and discuss the benefits and possible risks of sugammadex administration in the reversal of deep neuromuscular blockade in these operations.

The effect of moderate versus deep neuromuscular blockade on the surgical rating scale in laparoscopic sleeve gastrectomy in a Malaysian tertiary university hospital: a randomised clinical trial

“…Laparoscopic procedures can predispose to multiple cardiovascular complications as high intra-abdominal pressure results in increased afterload and a reduction in cardiac output. 18 Low intra-abdominal pressure may be beneficial for high-risk cardiac patients during laparoscopic surgery. 15 The average duration of surgery in our study was similar between the two groups.…”

Effects of a single dose of rocuronium in patients with different body fat percentages: A randomised controlled trial

“…Especially in laparoscopic surgery, the application of deep neuromuscular blockade during the operation is reported to improve patients' outcome. 2 Muscle relaxants induce profound neuromuscular block that can improve postoperative pain scores and quality of recovery 3 but also increase the risk of complications and can even result in death due to unreasonable use. 4 Postoperative residual curarization (PORC) is one of the high-risk factors for respiratory events after anaesthesia.…”

“…[11][12][13][14][15] Body mass index (BMI) is a recognised, reliable diagnostic criterion for obesity. BMI = weight (kg)/height (m) 2 . With the increasing concern about obesity, in 2003, the Working Organisation on Obesity in China (WGOC) proposed a cut-off value for determining overweight and obese Chinese adults based on large-scale survey data of the Chinese population.…”

“…They can provide muscle relaxation to meet the needs of surgical procedures. Especially in laparoscopic surgery, the application of deep neuromuscular blockade during the operation is reported to improve patients’ outcome 2 . Muscle relaxants induce profound neuromuscular block that can improve postoperative pain scores and quality of recovery 3 but also increase the risk of complications and can even result in death due to unreasonable use 4 .…”

Comparative study of analgesic efficacy of levobupivacaine alone and levobupivacaine plus dexmedetomidine in patients undergoing laparoscopic cholecystectomy

“…Laparoscopy has been a boon to the field of surgery for its different advantages over open surgery like a smaller and more cosmetic incision, reduced blood loss, reduced post-operative pain, faster recovery, faster discharge, and a subsequent decrease in health-care cost. 1 Early post-operative pain is the most common complication associated with laparoscopic surgeries. Pain after laparoscopy is due to stretching and inflammation of the peritoneum, irritation of the phrenic nerve, and residual carbon dioxide in the peritoneal cavity.…”