Spontaneous recovery of neuromuscular blockade is an independent risk factor for postoperative pulmonary complications after abdominal surgery: A secondary analysis.
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
entrez:
7
2
2020
pubmed:
7
2
2020
medline:
28
4
2021
Statut:
ppublish
Résumé
In intermediate-to-high-risk patients, major abdominal surgery is associated with a high incidence of postoperative complications, mainly pulmonary. Neuromuscular blocking drugs have been suggested as a contributing factor, but this remains unproven. To define the relationship of neuromuscular blockade management (reversal) with postoperative pulmonary complications (PPCs). The individualised PeRioperative Open-lung approach Versus standard protectivE ventilation in abdominal surgery study was a prospective, multicentre, four-arm, randomised controlled trial. This is a secondary analysis of the data. Twenty-one teaching hospitals in Spain. The study was conducted between 2 January 2015, and 18 May 2016. Age more than 18 years with an intermediate-to-high risk for PPCs, scheduled for major abdominal surgery lasting more than 2 h. Exclusion criteria included pregnancy or breastfeeding, and moderate-to-severe organ diseases. The mode of reversal of neuromuscular blockade determined two patient groups: pharmacological reversal versus spontaneous recovery. The primary outcome was a composite of PPCs during the first 30 postoperative days. The association between categorical variables and PPCs within 30 days was studied. Univariate and multivariable logistic regression modelling and propensity score analyses were performed. From the 923 patients included, 596 (64.6%) presented with PPCs within 30 days after surgery. Patients who developed these complications were older with a higher BMI, a lower pre-operative SpO2, a higher ASA physical status score and a higher incidence of arterial hypertension, diabetes mellitus or chronic obstructive pulmonary disease. Pharmacological neuromuscular blockade reversal was associated with a lower incidence of PPCs (odds ratio 0.62, 95% CI 0.47 to 0.82). Spontaneous recovery of neuromuscular blockade was an independent risk factor for PPCs in patients with intermediate-to-high risk, undergoing abdominal surgery. We suggest this factor should be included in future studies on PPCs. clinicaltrials.gov identifier: NCT02158923.
Sections du résumé
BACKGROUND
BACKGROUND
In intermediate-to-high-risk patients, major abdominal surgery is associated with a high incidence of postoperative complications, mainly pulmonary. Neuromuscular blocking drugs have been suggested as a contributing factor, but this remains unproven.
OBJECTIVE
OBJECTIVE
To define the relationship of neuromuscular blockade management (reversal) with postoperative pulmonary complications (PPCs).
DESIGN
METHODS
The individualised PeRioperative Open-lung approach Versus standard protectivE ventilation in abdominal surgery study was a prospective, multicentre, four-arm, randomised controlled trial. This is a secondary analysis of the data.
SETTING
METHODS
Twenty-one teaching hospitals in Spain. The study was conducted between 2 January 2015, and 18 May 2016.
PATIENTS
METHODS
Age more than 18 years with an intermediate-to-high risk for PPCs, scheduled for major abdominal surgery lasting more than 2 h. Exclusion criteria included pregnancy or breastfeeding, and moderate-to-severe organ diseases.
INTERVENTIONS
METHODS
The mode of reversal of neuromuscular blockade determined two patient groups: pharmacological reversal versus spontaneous recovery.
MAIN OUTCOME MEASURES
METHODS
The primary outcome was a composite of PPCs during the first 30 postoperative days. The association between categorical variables and PPCs within 30 days was studied. Univariate and multivariable logistic regression modelling and propensity score analyses were performed.
RESULTS
RESULTS
From the 923 patients included, 596 (64.6%) presented with PPCs within 30 days after surgery. Patients who developed these complications were older with a higher BMI, a lower pre-operative SpO2, a higher ASA physical status score and a higher incidence of arterial hypertension, diabetes mellitus or chronic obstructive pulmonary disease. Pharmacological neuromuscular blockade reversal was associated with a lower incidence of PPCs (odds ratio 0.62, 95% CI 0.47 to 0.82).
CONCLUSION
CONCLUSIONS
Spontaneous recovery of neuromuscular blockade was an independent risk factor for PPCs in patients with intermediate-to-high risk, undergoing abdominal surgery. We suggest this factor should be included in future studies on PPCs.
TRIAL REGISTRATION
BACKGROUND
clinicaltrials.gov identifier: NCT02158923.
Identifiants
pubmed: 32028288
doi: 10.1097/EJA.0000000000001128
pii: 00003643-202003000-00007
doi:
Banques de données
ClinicalTrials.gov
['NCT02158923']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
203-211Références
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