5 research outputs found
Incidência do bloqueio neuromuscular residual no pós-operatório: estudo observacional multicêntrico em Portugal (Inspire 2)
Congresso realizado no Porto, Portugal, de 29 abril a 1 de maio de 2021.info:eu-repo/semantics/publishedVersio
Incidence of postoperative residual neuromuscular blockade: a multicenter, observational study in Portugal (INSPIRE 2)
Background: Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal
intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess
RNMB incidence and management in Portugal.
Methods: Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of
patients arriving at postanesthesia care unit (PACU) with a TOF ratio ,0.9.
Results: A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the
most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine.
Twenty patients displayed a TOF ratio ,0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%–7.8%). Only two
patients displayed a TOF ratio ,0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (P 5 .114). In patients
with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%–8%), which varied significantly
according to the type of monitoring (P 5 .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate).
Conclusions: The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An
appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to
achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.info:eu-repo/semantics/publishedVersio
Incidence of postoperative residual neuromuscular blockade: a multicenter, observational study in Portugal (INSPIRE 2)
info:eu-repo/semantics/publishedVersio
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study
Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general
anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use
of neuromuscular blocking agents is associated with postoperative pulmonary complications.
Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in
28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital
procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge
were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination
within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative
pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were
adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and
adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513.
Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular
blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who
had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI
–5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised
without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49;
ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7)
were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex
instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at
a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes.
Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an
increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of
neuromuscular blockade against the increased risk of postoperative pulmonary complications