Muscle relaxation during laparoscopic surgeries of morbidly obese patients - Trial PACTR201710002663258

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Summary

Morbid obesity is associated with a decrease in the intra-abdominal space which represents one of the limiting factors on performing laparoscopic surgeries. The introduction of non-depolarizing muscle relaxants in clinical practice contributed to the Evolution in the anesthetic and surgical management of patients. The adequate use of non-depolarizing muscle relaxants allows the anesthetist to achieve a satisfactory operative goal while minimizing the doses of inhalational or intravenous anesthetics use.For a long period of time, maintaining deep neuromuscular block for optimizing surgical conditions was considered hazardous owing to the potential risk of awareness and residual curarisation in the postoperative period. Recent literature of Kopman revealed that deep neuromuscular block provides satisfactory surgical conditions during laparoscopy. However, there is a limited evidence of this statement.However, the main risk of the deep neuromuscular block is the increased risk of postoperative complications due to residual muscle.On anesthetizing morbid obese patients for laparoscopic surgeries, the controversy is usually exist about adjusting the dose of neuromuscular blockers for maintaining satisfactory surgical exposure while decreasing the risk of postoperative pulmonary complications.The new reversal agent of muscle relaxants, sugammadex allows complete and rapid reversal of rocuronium as compared to the traditional reversal by neostigmine. Thus, it may allow deep neuromuscular block during the intraoperative period for optimal surgical exposure and complete reversal of muscle relaxation for decreasing postoperative pulmonary complications.

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