Deep neuromuscular blockade in gynecological laparoscopic surgery: a review

Minimally invasive surgery has achieved remarkable progress during the last three decades in the field of operative gynecology. The intrinsic advantages of laparoscopy i.e. shorter operative time, less abdominal trauma, faster recovery and shorter hospitalization, combined with new advances in instrumentation, energy sources, and operative techniques, contributed to this shift towards laparoscopy for the operative management of a variety of gynecological conditions. One of the most important prerequisites for an effective and complications-free laparoscopic operation is the need to constantly maintain a good operative field. Concomitant advances in the area of anesthesia, like the use of objective neuromuscular monitoring and the introduction of new reversal agents have allowed clinicians to apply deep neuromuscular blockade (NMB) during laparoscopic operations with markedly reduced postoperative residual curarization. This evolution appears to contribute significantly to the establishment of a good operative field, especially during advanced and lengthy laparoscopic procedures, maintaining optimal conditions even when low-pressure laparoscopy (eight mmHg) is performed. The aim of this review is to present the principles of deep NMB and examine the possible benefits of its use during laparoscopy.