Deep Neuromuscular Block for Endolaryngeal Surgery: A Systematic Review and Meta‐Analysis.

Objectives: To determine the safety and efficacy of deep neuromuscular block (NMB) for endolaryngeal surgery. Data Sources: PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase, China National Knowledge Infrastructure, Wanfang, VIP databases, and trial registry database. Methods: Inclusion criteria followed the PICOS principles: Participants, adults undergoing endolaryngeal surgery; Intervention, deep NMB performed during the surgery; Control, no‐deep NMB performed; Outcomes, primary outcome: the incidence of clinically acceptable surgical conditions. Secondary outcome: the incidence of intraoperative complications (including vocal fold movement and coughing) and total incidence of postoperative complications [including postoperative residual curarization (PORC), postoperative sore throat (POST), and postoperative nausea and vomiting (PONV)]. Study design, randomized controlled trials (RCTs). Duplicate publications, editorials, letters, abstracts, and reviews were excluded. Results: Four articles with 242 patients were identified for analysis. The results indicated that compared with no‐deep NMB, deep NMB provides a higher incidence of clinically acceptable surgical conditions (98.36% vs. 76.67%; relative ratio [RR] = 1.29, 95% CI: 1.07–1.56), a lower incidence of intraoperative complications (10.83% versus 37.16%; RR = 0.32; 95% CI: 0.21–0.49) (lower incidence of vocal fold movement [1.85% vs. 34%; RR = 0.08, 95% CI: 0.02–0.41] and coughing [15.53% vs. 38.78%; RR = 0.42, 95% CI: 0.27–0.66]). There were no differences in the overall incidence of postoperative complications (RR = 2.10, 95% CI: 0.12–36.40). Conclusions: Based on current published evidence, deep NMB provides better surgical conditions with a higher incidence of clinically acceptable surgical conditions and a lower incidence of intraoperative complications (lower incidence of vocal fold movement and coughing) without increasing the overall incidence of postoperative complications. Level of Evidence: 1 Laryngoscope, 133:2055–2065, 2023 [ABSTRACT FROM AUTHOR]