Neuromuscular Blockade, Bariatric Surgeon Satisfaction, and Quality of Patient Recovery

Background: To date, little is known about neuromuscular blockade (NMB) and its impact in bariatric surgery and patient recovery. The goal of this study was to better assess the relationship between depth of NMB, bariatric surgeon’s satisfaction, and the quality of patient recovery. Methods: Between January and September 2015, we did a prospective observational study of 50 morbidly obese patients undergoing elective laparoscopic sleeve gastrectomy (LSG) under general anesthesia at our ambulatory surgical center. Rocuronium was used for tracheal intubation with bolus doses to maintain NMB. NMB was monitored at 5 minute intervals during the surgery, and at 30 second intervals following the reversal agent. The surgeon was blind to all anesthesia procedures and scored the surgical working conditions at 15 min intervals. Demographic data, operative data, and conditions were analyzed. Results: 42 females and 8 males, with a mean age of 38.8 years (range: 19 to 60, standard deviation (SD):±9.2), and mean BMI of 43.9 (range: 36 to 58, SD:± 5.1), underwent a LSG. Mean total surgical time was 63 minutes (range: 35 to 128). During the laparoscopic part of the surgery, 22% of the patients were in deep block and 78% were in moderate block. Six patients presented “poor” or “extremely poor” surgical conditions, and 6 patients had a sudden increase in intra-abdominal pressure. None of these patients were in deep block at that time. Patients in deep NMB had a shorter laparoscopic time (37 minutes, SD ± 7.1 vs 53 minutes, SD ± 18.3; P = 0.006). Conclusions: This study found that deep NMB prevents inappropriate abdominal cavity movement, consequently improving the operating area and the surgeon satisfaction.