Effect of shallow vs moderate neuromuscular blockade in major abdominal surgeries on post operative diaphragmatic function- a randomized controlled trial.

Neuromuscular blockade is a crucial pillar of GA. Recent evidence recommends moderate level of blockade for most surgical procedures causing patient immobility without deep muscle paralysis. The multi-centered POPULAR observational study suggests that use of neuromuscular blocking agents were associated with post operative pulmonary complications. Previous studies have compared deep vs moderate neuromuscular blockade in laparoscopic surgeries, demonstrating benefits of better operating conditions along with better post operative pain scores in deep block in long duration of surgeries. A recent prospective observational study has demonstrated that a lower diaphragmatic thickness fraction was associated with postoperative pulmonary complications. We therefore aim to assess the hypothesis that shallow neuromuscular blockade as compared to moderate blockade will improve diaphragmatic function and reduce POPC.