The effect of moderate versus deep neuromuscular blockade on the surgical rating scale in laparoscopic sleeve gastrectomy in a Malaysian tertiary university hospital: a randomised clinical trial

Background: The depth of neuromuscular blockade (NMB) is important to provide optimal space during laparoscopic surgery, especially in the obese population. This study compared the effects of moderate versus deep neuromuscular blockade on the surgical rating scale in laparoscopic sleeve gastrectomy. Methods: This single-blind, randomised controlled trial involved 24 patients with a body mass index > 30 kg/m2 who underwent laparoscopic sleeve gastrectomy. They were randomised into two groups: moderate NMB with a target train-of four (TOF) of 1-2 (Group M) and deep NMB with a post-tetanic count (PTC) of 1-2 (Group D). The quality of the surgical field was scored by a surgeon using the 5-point Surgical Rating Scale (SRS) from 1 (extremely poor condition) to 5 (optimal condition). The haemodynamic changes, end-tidal CO2, duration of surgery, and intra-abdominal pressure were also recorded. At the end of surgery, patients were given intravenous sugammadex at 2 mg/kg if the TOF count was 12, or 4 mg/kg if the PTC was 1-2. Patients were extubated when the TOF ratio (T4/T1) was greater than 0.9. Results: The mean SRS was significantly higher in Group D (4.83 ± 0.39) compared with Group M (4.08 ± 0.79), p = 0.004. All patients in Group D had favourable surgical conditions, in which 16.7% of patients achieved SRS of 4 and 83.3% had SRS of 5. In Group M, 8.3% of patients had an unfavourable surgical field. Conclusion: Deep NMB provided a favourable surgical condition compared with a moderate NMB in the laparoscopic sleeve gastrectomy.