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Muscle Relaxation in Laparoscopic Surgery

What is the Evidence for Improved Operating Conditions and Patient Outcome? A Brief Review of the Literature

Ledowski, Thomas MD, PD*,†

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2015 - Volume 25 - Issue 4 - p 281–285
doi: 10.1097/SLE.0000000000000164
Review Articles

When neuromuscular blocking agents (NMBA) were introduced into clinical practice in 1942, the event was called the “second revolution in anesthesia.” Despite some significant side effects, NMBAs have remained in the anesthetists’ repertoire, not at least because muscle relaxation has been claimed to allow or facilitate many surgical procedures. Aim of this literature review was to investigate the evidence for the use of NMBA as well as the optimum depth of neuromuscular blockade during laparoscopic surgery. Muscle relaxation may optimize laparoscopic operating conditions by preventing patient movement and achieving more intra-abdominal space for a given intra-abdominal insufflation pressure. In this context, deeper than normally maintained levels of neuromuscular blockade appear to be superior. However, the decision to utilize deeper than standard muscle relaxation should currently be based on a risk-benefit analysis for each individual patient. Thus good communication between surgeon and anesthetist remains crucial to achieve best outcomes.

*Department of Anaesthesia, Royal Perth Hospital

School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia

T.L. has consulted for and accepted a research grant from MSD, a manufacturer of muscle relaxants and sugammadex (reversal agent).

Reprints: Thomas Ledowski, MD, PD, School of Medicine and Pharmacology, University of Western Australia, Level 2 Royal Perth Hospital MRF Building, Rear 50 Murray Street, Perth, WA 6000, Australia (e-mail:

Received January 12, 2015

Accepted March 28, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.