Is Deep Neuromuscular Relaxation Beneficial in Laparoscopic, Abdominal Surgery?

T he core competence of anesthetists is to ensure perioperative patient safety and comfort and to provide the best possible surgical conditions (1). Muscle relaxants are important components of reaching these goals (1, 2). Neuromuscular blockade (NMB) facilitates intubation and may improve surgical conditions (3-6). Depending on the extent of NMB and the muscle relaxant used, spontaneous neuromuscular recovery may last significantly longer than the surgical intervention itself (7). This situation is not significantly altered by antagonizing with neostigmine. Thus, for many years, most anesthetists have avoided deep relaxation (train-of-four count [TOF count]=0, post tetanic count [PTC]=0) at the end of surgery (8, 9). In contrast, sugammadex allows fast and reliable recovery from any depth of NMB induced with rocuronium, vecuronium and pipecuronium after skin suture (9-13). This fact opens the opportunity of investigating possible indications for intraoperative deep NMB to improve surgical conditions. The need for and the clinical benefits of deep NMB are currently controversially discussed for several surgical procedures.