From the Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan (N.S.); Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (M.J.M.); Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (S.A.M., A.B.S., A.H.H.); MGH Anesthesia Research Grants, BWH Department of Preventive Medicine, and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.I.); Massachusetts General Hospital, Boston, Massachusetts (T.M., M.E.D.); and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, and Klinik fuer Anaesthesie und Intensivmedizin, Universitaetsklinikum Essen, Essen, Germany (M.E.).
Anesthesiology. 2014 Nov;121(5):959-68. doi: 10.1097/ALN.0000000000000440.
We tested the hypothesis that neostigmine reversal of neuromuscular blockade reduced the incidence of signs and symptoms of postoperative respiratory failure.
We enrolled 3,000 patients in this prospective, observer-blinded, observational study. We documented the intraoperative use of neuromuscular blocking agents and neostigmine. At postanesthesia care unit admission, we measured train-of-four ratio and documented the ratio of peripheral oxygen saturation to fraction of inspired oxygen (S/F). The primary outcome was oxygenation at postanesthesia care unit admission (S/F). Secondary outcomes included the incidence of postoperative atelectasis and postoperative hospital length of stay. Post hoc, we defined high-dose neostigmine as more than 60 μg/kg and unwarranted use of neostigmine as neostigmine administration in the absence of appropriate neuromuscular transmission monitoring.
Neostigmine reversal did not improve S/F at postanesthesia care unit admission (164 [95% CI, 162 to 164] vs. 164 [161 to 164]) and was associated with an increased incidence of atelectasis (8.8% vs. 4.5%; odds ratio, 1.67 [1.07 to 2.59]). High-dose neostigmine was associated with longer time to postanesthesia care unit discharge readiness (176 min [165 to 188] vs. 157 min [153 to 160]) and longer postoperative hospital length of stay (2.9 days [2.7 to 3.2] vs. 2.8 days [2.8 to 2.9]). Unwarranted use of neostigmine (n = 492) was an independent predictor of pulmonary edema (odds ratio, 1.91 [1.21 to 3.00]) and reintubation (odds ratio, 3.68 [1.10 to 12.4]).
Neostigmine reversal did not affect oxygenation but was associated with increased atelectasis. High-dose neostigmine or unwarranted use of neostigmine may translate to increased postoperative respiratory morbidity.
我们检验了这样一个假设，即新斯的明逆转神经肌肉阻滞作用可降低术后呼吸衰竭的体征和症状发生率。
我们前瞻性地纳入了 3000 例患者，进行了观察者设盲的观察性研究。我们记录了术中使用神经肌肉阻滞剂和新斯的明的情况。在麻醉后恢复室（PACU）入院时，我们测量了肌颤搐比，并记录了外周血氧饱和度与吸入氧分数（S/F）的比值。主要结局为 PACU 入院时的氧合（S/F）。次要结局包括术后肺不张的发生率和术后住院时间。事后，我们将大剂量新斯的明定义为超过 60μg/kg，将不必要使用新斯的明定义为在没有适当神经肌肉传递监测的情况下使用新斯的明。
新斯的明逆转并未改善 PACU 入院时的 S/F（164 [95% CI，162 至 164] 比 164 [161 至 164]），并与肺不张发生率增加相关（8.8% 比 4.5%；比值比，1.67 [1.07 至 2.59]）。大剂量新斯的明与 PACU 出院准备时间延长相关（176 分钟 [165 至 188] 比 157 分钟 [153 至 160]），术后住院时间延长（2.9 天 [2.7 至 3.2] 比 2.8 天 [2.8 至 2.9]）。不必要使用新斯的明（n=492）是肺水肿（比值比，1.91 [1.21 至 3.00]）和再次插管（比值比，3.68 [1.10 至 12.4]）的独立预测因素。
新斯的明逆转并未影响氧合，但与肺不张增加有关。大剂量新斯的明或不必要使用新斯的明可能会导致术后呼吸并发症增加。
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