Cammu Guy
Anesthesiology, Critical Care and Emergency Medicine, Onze-Lieve-Vrouw Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.
Curr Anesthesiol Rep. 2020;10(2):131-136. doi: 10.1007/s40140-020-00388-4. Epub 2020 Mar 27.
The purpose of this review is to assess how residual neuromuscular block impacts postoperative pulmonary complications and whether we can modify the risk by improving certain aspects in daily clinical care.
Postoperative respiratory impairment may be due to various causes, such as age, surgery type, comorbidity, smoking, preoperative anemia, and general anesthesia. However, increasing evidence suggests that residual neuromuscular block is an important risk factor for postoperative pulmonary complications and may affect the outcome. Conflicting data from some recent reports show that the use of quantitative neuromuscular monitoring alone does not preclude residual neuromuscular block and that improvements in the interpretation of neuromuscular monitoring may be required. Pulmonary complications seem to be reduced for train-of-four ratios > 0.95 before tracheal extubation compared with > 0.9.
This review stresses the need for appropriate management of neuromuscular block in the prevention of postoperative pulmonary complications but acknowledges that the causes are multifactorial.
本综述旨在评估残余神经肌肉阻滞如何影响术后肺部并发症，以及我们是否可以通过改善日常临床护理的某些方面来降低风险。
术后呼吸功能受损可能由多种原因引起，如年龄、手术类型、合并症、吸烟、术前贫血和全身麻醉。然而，越来越多的证据表明，残余神经肌肉阻滞是术后肺部并发症的重要危险因素，可能影响预后。最近一些报告的相互矛盾的数据表明，仅使用定量神经肌肉监测并不能排除残余神经肌肉阻滞，可能需要改进神经肌肉监测的解读。与比值>0.9相比，气管拔管前四个成串刺激比值>0.95时肺部并发症似乎减少。
本综述强调在预防术后肺部并发症时对神经肌肉阻滞进行适当管理的必要性，但也承认其原因是多因素的。
