Deep versus moderate neuromuscular block in laparoscopic bariatric surgeries: effect on surgical conditions and pulmonary complications

Background: The aim of this study was to evaluate the effect of deep and moderate neuromuscular block on surgical exposure quality, intraoperative lung mechanics, and postoperative respiratory functions, during laparoscopic bariatric surgery. Methods: Sixty adult morbid obese patients were enrolled in the study. They were randomly distributed in two equal groups: the deep block group, where rocuronium infusion was given to maintain the post-tetanic counts above 1, and the moderate block group, where increments of rocuronium were delivered to maintain the train of four 1-2. The surgeon was asked to assess intraoperative relaxation. The increase in intra-abdominal pressure and reported abdominal or diaphragmatic movements were recorded. Intraoperative lung mechanics were studied, and preoperative and postoperative pulmonary function tests were done. Results: The scores reported by the surgeons for intraoperative surgical exposure were indifferent among the two groups (5 (4-5) in the deep block group and 4 (3-5) in the moderate block group, P = 0.243). The difference in the increase in intra-abdominal pressure and reported abdominal or diaphragmatic movements was insignificant between both (P = 0.299 and 0.424). Intraoperative pulmonary mechanics and postoperative pulmonary functions were comparable (P > 0.05), and the postoperative pain score was indifferent between both groups (P > 0.05). Conclusion: During laparoscopic bariatric surgery of morbidly obese patients, the quality of abdominal relaxation and surgical exposure, intraoperative lung mechanics, and postoperative pulmonary functions were indifferent with the use of moderate or deep neuromuscular block.