EVALUATION OF INTRAPERITONEAL PRESSURE IN LAPAROSCOPIC SLEEVE GASTRECTOMY BY USING DEEP NEUROMUSCULAR BLOCK VERSUS ADEQUATE NEUROMUSCULAR BLOCK

Background: In recent review Kopman and Naguib suggest that the benefit of deep neuromuscular block may be nonexistent, this is surprising conclusion given the increasing amount of literatures on this topic that dose show a significant clinical benefit from deep neuromuscular block. Aim of study: Study the effect of deep neuromuscular block on the intraperitoneal pressure during laparoscopic sleeve gastrectomy and the surgical workspace by comparing between adequate and deep neuromuscular block. Patient and Methods: 50 randomly chosen patients scheduled for elective laparoscopic sleeve gastrectomy were included in our study, they were divided into two groups; group 1 (25 patients with adequate neuromuscular blockade and intraperitoneal pressure of 15 mmHg) and group 2 (25 patients with deep neuromuscular blockade and intraperitoneal pressure as low as possible decided by single qualified surgeon). The neuromuscular block level was monitored during operation every 10 min. and maintained by rocuronium in both groups. The vital signs were recorded every 10 min. during the surgery. Neuromuscular block was reversed at the end of surgery by sugammadex, surgeon satisfaction was obtained at the end of surgery according to the visual analogue scale. Results: The vital signs were significantly improved in group 2 specially the mean arterial pressure which was significantly lower than group 1 due to deep level of neuromuscular block and low intraperitoneal pressure (14 or 13 mmHg), while the surgeon satisfaction remain at the same level in both groups; that means the quality of surgical workspace not altered by lowering the intraperitoneal pressure. Conclusions: The use of deep neuromuscular block with lowest intraperitoneal pressure possible to optimize the surgical workspace and keep the cardiovascular condition uncompromised.