Deep neuromuscular block does not improve surgical conditions for laparoscopic renal surgery.

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• G H Maarten Honing, Christian H Martini, Erik Olofsen, Bevers Rob F M RFM Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands., Volkert A L Huurman, Alwayn Ian P J IPJ Department of Transplant Surgery and Transplant Centre, Leiden University Medical Centre, Leiden, The Netherlands., Monique van Velzen, Marieke Niesters, Aarts Leon P H J LPHJ Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Albert Dahan, and Martijn Boon.
• Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
• Br J Anaesth. 2021 Feb 1; 126 (2): 377-385.

BackgroundDeep neuromuscular block is associated with improved working conditions during laparoscopic surgery when propofol is used as a general anaesthetic. However, whether deep neuromuscular block yields similar beneficial effects when anaesthesia is maintained using volatile inhalation anaesthesia has not been systematically investigated. Volatile anaesthetics, as opposed to intravenous agents, potentiate muscle relaxation, which potentially reduces the need for deep neuromuscular block to obtain optimal surgical conditions. We examined whether deep neuromuscular block improves surgical conditions over moderate neuromuscular block during sevoflurane anaesthesia.MethodsIn this single-centre, prospective, randomised, double-blind study, 98 patients scheduled for elective renal surgery were randomised to receive deep (post-tetanic count 1-2 twitches) or a moderate neuromuscular block (train-of-four 1-2 twitches). Anaesthesia was maintained with sevoflurane and titrated to bispectral index values between 40 and 50. Pneumoperitoneum pressure was maintained at 12 mm Hg. The primary outcome was the difference in surgical conditions, scored at 15 min intervals by one of eight blinded surgeons using a 5-point Leiden-Surgical Rating Scale (L-SRS) that scores the quality of the surgical field from extremely poor1 to optimal5.ResultsDeep neuromuscular block did not improve surgical conditions compared with moderate neuromuscular block: mean (standard deviation) L-SRS 4.8 (0.3) vs 4.8 (0.4), respectively (P=0.94). Secondary outcomes, including unplanned postoperative readmissions and prolonged hospital admission, were not significantly different.ConclusionsDuring sevoflurane anaesthesia, deep neuromuscular block did not improve surgical conditions over moderate neuromuscular block in normal-pressure laparoscopic renal surgery.Clinical Trial RegistrationNL7844 (www.trialregister.nl).Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

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