• M V Madsen, S Scheppan, E Mørk, P Kissmeyer, J Rosenberg, and M R Gätke.
• Department of Anesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.
• Br J Anaesth. 2017 Sep 1; 119 (3): 435-442.

BackgroundDuring laparotomy, surgeons may experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. Deep neuromuscular block (NMB), defined as a post-tetanic-count (PTC) between 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesized that deep NMB (PTC 0-1) would improve subjective ratings of surgical conditions during upper laparotomy as compared with standard NMB.MethodsThis was a double blinded, randomized study. A total of 128 patients undergoing elective upper laparotomy were randomized to either continuous deep NMB (infusion of rocuronium 2 mg ml -1 ) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia). Surgical conditions were evaluated using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min. Primary outcome was the average of scores for a patient's surgical conditions. Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection.ResultsDeep compared with standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3-5) compared with 4.00 (range 1-5) ( P <0.001), respectively. Deep compared with standard NMB resulted in better ratings of surgical conditions during fascial closure ( P <0.001), fewer episodes of need to optimize surgical conditions ( P <0.001), and fewer incidents with sudden movements ( P <0.001). No differences in operating time, occurrence of wound infection, and wound dehiscence were found.ConclusionsDeep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy.Clinical Trial RegistrationNCT02140593.© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

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