Neuromuscular block in laparoscopic surgery

There is an increased interest in the current literature to evaluate the potential clinical benefit of a sustained deep neuromuscular blockade (i.e. a post-tetanic count ≤3) during various laparoscopic surgical procedures. This deep block concept represents a new area of clinical research, which concerns both, anesthesiologists and surgeons. We reviewed a selection of recent publications about the indications and the potential benefits of a maintained deep neuromuscular blockade during different laparoscopic procedures. Moreover, the contribution of the diaphragmatic relaxation to the overall surgical conditions is also highlighted. There is convincing evidence that deep neuromuscular blockade compared to moderate neuromuscular block improves surgical conditions, at least for the following surgical procedures: laparoscopic cholecystectomy, prostatectomy, nephrectomy and laparoscopic bariatric surgery. Moreover, first evidence suggests that deep block may reduce perioperative surgical complications and improve patient's outcome. There are situations during laparoscopic surgery where a better communication between surgeon and anesthesiologist may improve patient's outcome. Moreover, clinical research has now to identify which additional procedures and type of patients may benefit most from this new deep block concept and ultimately, whether the implementation of a routine deep neuromuscular block may affect patient's outcome.