IMR Press / CEOG / Volume 44 / Issue 6 / DOI: 10.12891/ceog3736.2017

Clinical and Experimental Obstetrics & Gynecology (CEOG) is published by IMR Press from Volume 46 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Review
Deep neuromuscular blockade in gynecological laparoscopic surgery: a review
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1 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, University of Athens, Athens, Greece
2 Department of Anaesthesiology, Alexandra Hospital, University of Athens, Athens, Greece
Clin. Exp. Obstet. Gynecol. 2017, 44(6), 824–833; https://doi.org/10.12891/ceog3736.2017
Published: 10 December 2017
Abstract

Minimally invasive surgery has achieved remarkable progress during the last three decades in the field of operative gynecology. The intrinsic advantages of laparoscopy i.e. shorter operative time, less abdominal trauma, faster recovery and shorter hospitalization, combined with new advances in instrumentation, energy sources, and operative techniques, contributed to this shift towards laparoscopy for the operative management of a variety of gynecological conditions. One of the most important prerequisites for an effective and complications-free laparoscopic operation is the need to constantly maintain a good operative field. Concomitant advances in the area of anesthesia, like the use of objective neuromuscular monitoring and the introduction of new reversal agents have allowed clinicians to apply deep neuromuscular blockade (NMB) during laparoscopic operations with markedly reduced postoperative residual curarization. This evolution appears to contribute significantly to the establishment of a good operative field, especially during advanced and lengthy laparoscopic procedures, maintaining optimal conditions even when low-pressure laparoscopy (eight mmHg) is performed. The aim of this review is to present the principles of deep NMB and examine the possible benefits of its use during laparoscopy.
Keywords
Laparoscopy
Deep neuromuscular blockade
Gynaecology
Neuromuscular monitoring
Operating field improvement
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