MRI measurement of the effects of moderate versus deep neuromuscular blockade on the abdominal working space during laparoscopic surgery in a prospective cohort study.

Patient safety during laparoscopy has great priority. Recent studies using deep
muscle relaxation showed that surgeons prefer deep neuromuscular blockade,
because of improved surgical space conditions. Several animal studies, which
assessed the influence of neuromuscular blockade on the intra-abdominal space
in pigs, did not support these outcomes. They doubt the reliability of the
subjective surgeon-rated quality of the surgical field. Therefore we will
assess the effects of deep neuromuscular blockade during laparoscopy on the
abdominal space, measured by MRI.

The effect of deep muscle relaxation on the abdominal working space during
laparosopy, measured by MRI.

Single center study
Prospective cohort study

Following induction of general anesthesia and creation of pneumoperitoneum,
each patiënt will undergo a MRI scan in 3 phases
(total duration 30 minutes)

- phase 1: no NMB (first scan)
- phase 2: moderate NMB (second scan)
- phase 3: deep NMB (third scan)

Minimal burden, since the assessment of the effects of deep neuromuscular
blockade during surgery are performed during general anesthesia. The MRI will
be performed during general anesthesia, which will be lengthened with
approximately 30 minutes.

Negligible risk, with a small chance of minimal harm.
The extended effects of deep neuromuscular blockade can lead to post-operative
complications, such as airway obstruction, hypoxia, pneumonia and/or
atelectasis. Therefore, sugammadex, a rapid antagonist of neuromuscular
blockade is given immediately after surgery. Randomized controlled trials have
shown that sugammadex can be safely administered in patients.