Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Kiekkas, Panagiotis; Bakalis, Nick; Stefanopoulos, Nikolaos; Konstantinou, Evangelos; Αρέθα, Διαμάντω

doi:10.1111/jocn.12508

Cited by 13 publications

(7 citation statements)

References 33 publications

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“…This study however, did not observe any significant association between the type of muscle relaxants and PPCs. However, significant association between duration of surgery/anesthesia and PPCs was observed in this study, contrary to the studies by Nertila et al12 and Kiekkas .et al36 The shorter duration of surgery and anesthesia for most participants in this study might have minimized the residual effect of these muscle relaxants. Many of the surgeries in this study lasted <2 hours as these effects are more evident in prolonged surgeries.…”

Section: Discussioncontrasting

confidence: 96%

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

et al. 2019

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Background and Objectives Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. Methodology This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. Results The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). Conclusion The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs.

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Section: Discussioncontrasting

confidence: 96%

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

et al. 2019

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“… 43 Postoperative residual curarization is a safety hazard to surgical patients and strongly affects the prognosis. 44 , 45 Special attention needs to be paid to it. A large prospective observational multicenter study conducted by Kirmeier et al described that the total dose of neuromuscular blocking medicine during the operation was directly associated with an increased risk of post-anaesthetic pulmonary complications.…”

Section: Disadvantages Of the Application Of Deep Neuromuscular Blockadementioning

confidence: 99%

Sugammadex, the Guardian of Deep Muscle Relaxation During Conventional and Robot-Assisted Laparoscopic Surgery: A Narrative Review

Sun

Wang

et al. 2021

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High intra-abdominal pressure induced by artificial pneumoperitoneum can obviously impair respiratory and circulatory functions and has a negative effect on the prognosis of patients undergoing conventional and robot-assisted laparoscopic surgery. The application of deep neuromuscular blockade during the operation is reported to lower the intra-abdominal pressure and improve patients’ outcome. However, concern lies in the risks of postoperative residual muscular paralysis with the use of deep neuromuscular blockade. Sugammadex, a specific antagonist for aminosteroids muscle relaxants, can effectively and rapidly reverse rocuronium and vecuronium induced neuromuscular blockade of different depths. Thus, sugammadex allows the ability to safeguard the application of deep neuromuscular blockade in laparoscopic operations and helps to alleviate the adverse complications associated with pneumoperitoneum. Here, we review the application of deep neuromuscular blockade in different laparoscopic surgeries and discuss the benefits and possible risks of sugammadex administration in the reversal of deep neuromuscular blockade in these operations.

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“…These adverse events include cardiovascular or respiratory complications (Buhre and Rossaint 2003). Therefore, areas known as post-anaesthesia care units (PACU) have been established in many hospitals worldwide, which are intended to provide specialised care and minimise morbidity and mortality through the timely detection or prevention of adverse events (Kiekkas et al 2014). In clinical practice, neuromuscular blocking drugs (NMBDs) are commonly used by anaesthesiologists during general anaesthesia in order to maintain optimal surgical conditions by maintaining deep muscle relaxation and to facilitate tracheal intubation (Claudius et al 2009).…”

Section: Introductionmentioning

confidence: 99%

The association between residual neuromuscular blockade (RNMB) and critical respiratory events: a prospective cohort study

et al. 2021

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Background Inadequate neuromuscular recovery might impair pulmonary function among adult patients who undergo general anaesthesia and might thus contribute to critical respiratory events in the post-anaesthesia care unit (PACU). The pilot study aims to understand the baseline incidence of residual neuromuscular blockade (RNMB) and postoperative critical respiratory events (CREs), which are described in a modified Murphy’s criteria in the PACU. Method This is a prospective cohort study from January to March 2017 from a tertiary hospital in Saudi Arabia with thirty adult patients over 18 years old scheduled for elective surgery under general anaesthesia with neuromuscular blocking drugs (NMBDs) who were enrolled in the study. The Mann-Whitney U tests, chi-square tests and independent-samples T tests were used. The train-of-four (TOF) ratios were measured upon arrival in the PACU by using acceleromyography with TOF-Scan. Subjects’ demographics, perioperative data and the occurrence of postoperative CREs in the PACU were recorded. Results Twenty-six (86.7%) patients out of thirty in the study have received rocuronium as NMBDs whilst neostigmine as a reversal drug with only 23 (76.7%). The incidence of RNMB (TOF ratio < 0.9) was in 16 patients (53.3%). The incidence of RNMB was significantly higher in female patients (p = 0.033), in patients who had not undergone quantitative neuromuscular monitoring before extubation (p = 0.046) and in patients with a shorter duration of surgery (p = 0.001). Postoperative CREs occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with RNMB (p = 0.001). In addition, a statistically significant difference was observed in the occurrence of CREs according to body mass index (p = 0.047). Conclusion This research showed that RNMB is a significant contributing factor to the development of critical respiratory events during PACU stay. Therefore, routine quantitative neuromuscular monitoring is recommended to reduce the incidence of RNMB.

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Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Cited by 13 publications

References 33 publications

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

Sugammadex, the Guardian of Deep Muscle Relaxation During Conventional and Robot-Assisted Laparoscopic Surgery: A Narrative Review

The association between residual neuromuscular blockade (RNMB) and critical respiratory events: a prospective cohort study

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