Background: There is a controversy in the literature whether deep compared with moderate neuromuscular block (NMB) improves surgical conditions for laparoscopic surgery. Objectives: The primary outcome measure was to examine whether switching from moderate to deep NMB improves surgical conditions for laparoscopic obese surgery; secondary outcome measures were changes in intraabdominal pressure, duration to perform gastro-jejunal anastomosis, and perioperative surgical complications.Design: A single center, randomized controlled study. Each patient was taken as its own control and examined twice: at the first evaluation (E1) all patients had a moderate NMB, thereafter patients were randomized to deep or moderate block and a second evaluation (E2) was performed within 10 min. Patients with excellent rating at E1 were excluded from E2 as they could not further improve their surgical conditions.
Setting: University Hospital FrancePatients: Patients undergoing laparoscopic gastric bypass surgery under general anaesthesia were included. Main exclusion criteria were hypersensitivity to drugs used and absence of written informed consent.Interventions: According to the group assignment patients received bolus doses of rocuronium or 0.9% saline.Main Outcome Measures: Surgical conditions were assessed with a 4-point rating scale. Intraoperative adverse events were assessed with the Kaafarani-classification and postoperative complications with the Clavien-Dindo-classification.Results: 89 patients were initially included and data from 85 patients could assessed at E1; surgical rating was excellent in 20, good in 35, acceptable in 18, poor in 12. After excluding those with excellent rating, the remaining 65 patients were randomly assigned to deep or moderate block. At E2 an improvement of surgical conditions was observed in 29/34 patients with deep block and in 4/31 with moderate block; p< 0.0001.Poor surgical conditions were more frequently associated with surgical complications (61.5% versus 15.3%; p<0.001).
Conclusion:Switching from moderate to deep block improves surgical conditions. Poor surgical conditions were associated with a higher incidence of surgical complications.
