• Anne K Staehr-Rye, Lars S Rasmussen, Jacob Rosenberg, Poul Juul, and Mona R Gätke.
• Anæstesiologisk Afdeling, Herlev Hospital, 2730 Herlev, Denmark. anne.kathrine.staehr@regionh.dk
• Dan Med J. 2013 Feb 1;60(2):A4579.

IntroductionLaparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (< 12 mmHg), but surgical conditions may not be optimal. The present study aimed at comparing surgical space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mmHg) LC. We hypothesized that a deep neuromuscular block would be associated with a higher proportion of optimal surgical space conditions.Material And MethodsThis was an investigator-initiated, patient- and assessor-blinded study. Up to 72 patients scheduled for elective LC were randomised to either deep neuromuscular blockade (post-tetanic count 0-1) or moderate neuromuscular blockade, where at least one response to train-of-four nerve stimulation was present. The primary outcome was surgical space conditions at the time during surgery when conditions were worst. The secondary outcomes included the proportion of procedures completed at pneumoperitoneum 8 mmHg, post-operative pain, and incidence of nausea and vomiting.ResultsThis study was the first randomised study to assess the association between depth of neuromuscular blockade and surgical space conditions during low-pressure LC. The study findings may be applicable to a general surgical population undergoing LC.FundingThe University of Copenhagen, Denmark and Sophus Johansens Foundation of 1981, Denmark funded this study, which was also financed by a research grant from the Investigator Initiated Studies Program of Merck Sharp and Dohme Corp.Trial RegistrationNCT 01523886.

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