Madsen MV, et al. - This study compared deep neuromuscular block (NMB) [post-tetanic-count (PTC) 0-1] with standard NMB in terms of subjective ratings of surgical conditions during upper laparotomy, presuming that deep NMB (PTC 0-1) would improve these ratings. Findings demonstrated that compared to standard NMB, deep NMB afforded better subjective ratings of surgical conditions during laparotomy.

Methods

• In this double blinded, randomized study, researchers randomized a total of 128 patients undergoing elective upper laparotomy to either continuous deep NMB (infusion of rocuronium 2 mg ml^-1) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia).
• They assessed surgical conditions using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min.
• Primary outcome was the average of scores for a patient’s surgical conditions.
• Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection.

Results

• Findings demonstrated that deep versus standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3–5) compared with 4.00 (range 1–5) (P<0.001), respectively.
• Researchers observed that deep compared with standard NMB resulted in better ratings of surgical conditions during fascial closure (P<0.001), fewer episodes of need to optimize surgical conditions (P<0.001), and fewer incidents with sudden movements (P<0.001).
• They found no differences in operating time, occurrence of wound infection, and wound dehiscence.