Hypoxic ventilatory response after rocuronium‐induced partial neuromuscular blockade in men with obstructive sleep apnoea

Abstract

Obstructive sleep apnoea and residual neuromuscular blockade are, independently, known to be risk factors for respiratory complications after major surgery. Residual effects of neuromuscular blocking agents are known to reduce the hypoxic ventilatory response in healthy volunteers. Patients with obstructive sleep apnoea have impaired control of breathing, but it is not known to what extent neuromuscular blocking agents interfere with the regulation of breathing in such patients. In a physiological study in 10 unsedated men with untreated obstructive sleep apnoea, we wished to examine if partial neuromuscular blockade had an effect on hypoxic ventilatory response (isocapnic hypoxia to oxygen saturation of 80%) and hypercapnic ventilatory response (normoxic inspired carbon dioxide 5%). The hypoxic ventilatory response was reduced by 32% (p = 0.016) during residual neuromuscular block (rocuronium to train-of-four ratio 0.7), but the hypercapnic ventilatory response was unaffected. We conclude that neuromuscular blockade specifically depresses peripheral chemosensitivity, and not respiratory muscle function since the hypercapnic ventilatory response was unaffected.

Use of rocuronium and sugammadex for video-assisted thoracoscopic surgery is associated with reduced duration of chest tube drainage: a propensity score-matched analysis

“…9,10 Neuromuscular blocking agents are widely administered during general anaesthesia in thoracic surgery to facilitate tracheal and bronchial intubation with a double-lumen tube and subsequent mechanical ventilation. However, postoperative residual neuromuscular block is associated with various pulmonary complications, 11 including impaired pharyngeal and pulmonary function, 12 poor hypoxic ventilatory drive, 13 pneumonia, 14 aspiration, atelectasis, respiratory distress, and subsequent reintubation. 15e17 In addition, traditional reversal drugs, such as neostigmine, have limited effects in antagonising deep levels of neuromuscular block.…”

Sleep disturbances and residual neuromuscular blockade: future research possibilities: a reply

“…We thank Medina et al. for their interest in our recent article . We agree that it would be interesting to include a larger sample of patients with obstructive sleep apnoea, particularly after they have received an initial 3 months of continuous positive airway pressure (CPAP) treatment.…”

Sleep disturbances and residual neuromuscular blockade: future research possibilities

“…We read with great interest the article by Christensson et al [1] investigating how partial neuromuscular blockade interferes with the regulation of breathing in patients with obstructive sleep apnoea (OSA). This was a physiological study performed in 10 unsedated male volunteers.…”