Quest Volume 4 Number 2

Contents: IYPE Out of Africa - South African National Committee for the International Year of Planet Earth - The world celebrates and the Earth sciences get down to business Features: African landscapes from remote sensing - Clear views in 3D: Climate: past changes & future uncertainties - Reading the rock record helps: Megacities - Coping with urbanization: Viewpoint Mineral resources - wealth at a frightening price People and planet pay up: Earth: gigantic recycling machine: How the planet sustains life Africa Array - Seismic stations and geoscientists Ocean crossroad at the tip of Africa: Where the waters move and meet DNA clocks for dating landforms - Animals and landscapes evolve together: Groundwater: managing dwindling reserves - Finding and caring for precious water Geohazards: the risks beneath our feet - Staying safe: Nurturing soil - It's payback time: Healthy foods from Mother Earth - Pioneering dietary guidelines: Art and map-making - Seeing the world in different ways: Africa Alive Corridors - Our continent - our heritage: Fact files - Urban facts -What is soil? - Malnutrition in South Africa: Your questions answered - Why does oceanography matter? What makes oceans salty?: The S&T tourist Water in the iSimangaliso - Wetland Park: Careers Work in geology:The Department of Science and Innovation: Academy of Science of South Afric

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