Many surgical procedures are performed using the laparoscopic approach. However, insufflation of the abdomen (pneumoperitoneum) has detrimental hemodynamic effects. The investigators intend to investigate the effect of deep neuromuscular block and nociception guided anaesthesia on hemodynamic variables during pneumoperitoneum for lower abdominal laparoscopic surgery.

Inclusion Criteria:

ASA 1-3;

• Scheduled for lower laparoscopic abdominal surgery;
• Ability to give oral and written consent;

Exclusion Criteria:

• Known or suspected neuromuscular disorders impairing neuromuscular function;
• Allergies to muscle relaxants, anesthetics or narcotics;
• A (family) history of malignant hyperthermia;
• Women who are or may be pregnant;
• Preexisting cardiac disease (any);
• Untreated or uncontrolled hypertension;
• COPD gold 3 or higher
• Preexistent esophageal pathology (stricture, tumor, diverticulum)
• Any increased risk factor for upper gastro intestinal tract bleed:
• History of GI surgery;
• History of GI bleed;
• Esophageal varices;
• Gastric or esophageal inflammation;
• Severe thrombocytopenia (less than 50k) or severely elevated INR (>4).