Faculty Collaboration Database

Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ 2012 Oct 15;345:e6329

Date

10/19/2012

Pubmed ID

23077290

Pubmed Central ID

PMC3473088

DOI

10.1136/bmj.e6329

Scopus ID

2-s2.0-84868026876 (requires institutional sign-in at Scopus site)   214 Citations

Abstract

OBJECTIVE: To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications.

DESIGN: Prospective, propensity score matched cohort study.

SETTING: General teaching hospital in Boston, Massachusetts, United States, 2006-10.

PARTICIPANTS: 18,579 surgical patients who received intermediate acting neuromuscular blocking agents during surgery were matched by propensity score to 18,579 reference patients who did not receive such agents.

MAIN OUTCOME MEASURES: The main outcome measures were oxygen desaturation after extubation (hemoglobin oxygen saturation <90% with a decrease in oxygen saturation after extubation of >3%) and reintubations requiring unplanned admission to an intensive care unit within seven days of surgery. We also evaluated effects on these outcome variables of qualitative monitoring of neuromuscular transmission (train-of-four ratio) and reversal of neuromuscular blockade with neostigmine to prevent residual postoperative neuromuscular blockade.

RESULTS: The use of intermediate acting neuromuscular blocking agents was associated with an increased risk of postoperative desaturation less than 90% after extubation (odds ratio 1.36, 95% confidence interval 1.23 to 1.51) and reintubation requiring unplanned admission to an intensive care unit (1.40, 1.09 to 1.80). Qualitative monitoring of neuromuscular transmission did not decrease this risk and neostigmine reversal increased the risk of postoperative desaturation less than 90% (1.32, 1.20 to 1.46) and reintubation (1.76, 1.38 to 2.26).

CONCLUSION: The use of intermediate acting neuromuscular blocking agents during anesthesia was associated with an increased risk of clinically meaningful respiratory complications. Our data suggest that the strategies used in our trial to prevent residual postoperative neuromuscular blockade should be revisited.

Author List

Grosse-Sundrup M, Henneman JP, Sandberg WS, Bateman BT, Uribe JV, Nguyen NT, Ehrenfeld JM, Martinez EA, Kurth T, Eikermann M

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cholinesterase Inhibitors
Female
Humans
Hypoxia
Infant
Intubation, Intratracheal
Length of Stay
Male
Middle Aged
Muscle, Skeletal
Neostigmine
Neuromuscular Nondepolarizing Agents
Postoperative Complications
Prognosis
Propensity Score
Prospective Studies
Respiration, Artificial
Respiratory Insufficiency
Retreatment
Risk Factors
Young Adult