Raval Amit D, Anupindi Vamshi Ruthwik, Ferrufino Cheryl P, Arper Diana L, Bash Lori D, Brull Sorin J
Merck & Co., Inc., Center for Observational and Real-World Evidence, 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA.
IQVIA, Inc., 3110 Fairview Park Drive, Suite 400, Falls Church, VA 22042, USA.
J Clin Anesth. 2020 Nov;66:109962. doi: 10.1016/j.jclinane.2020.109962. Epub 2020 Jun 22.
Complete reversal of neuromuscular blockade (NMB) is important for patient safety and prognosis following surgical procedures involving NMB agents (NMBAs). Published evidence on the epidemiology and consequences of residual neuromuscular blockade (rNMB; incomplete neuromuscular recovery) in real-world clinical settings is lacking with advances in NMB management. Therefore, we aimed to examine the burden of rNMB and its associated clinical, economic and humanistic outcomes using a systematic review framework.
Electronic and conference database searches were performed to include observational studies examining rNMB or related outcomes in adults undergoing surgery and receiving NMBAs with or without NMBA antagonists.
Of 1438 screened abstracts, 58 studies with 25,277 total patients were included. Inconsistent definitions of rNMB were reported across studies with 44 (76%) and 29 (50%) studies utilizing quantitative and qualitative measures to detect rNMB, respectively. The most common definition of rNMB was train-of-four ratio (TOFR) <0.9 (29 studies) and TOFR <0.7 (16 studies) measured at post-anesthesia care unit (PACU) entry. For TOFR <0.9 at PACU entry, rNMB incidence ranged from 0% to 90.5% (median 30%) overall; 0% to 16.0% in the sugammadex (SUG) group; 3.5% to 90.5% in the neostigmine (NEO) group; and 15% to 89% in the spontaneous recovery (SR) group. Twenty-one studies reported clinical outcomes (reintubation, mild hypoxemia, or a respiratory event) or resource utilization outcomes (hospital/PACU length of stay [LOS]) by presence/absence of rNMB. Patients with rNMB had higher rates of acute respiratory events compared to those without rNMB.
Real-world observational studies show a significant burden of rNMB and associated health sequelae, though rNMB measures were not reported consistently across studies. Appropriate quantitative measurement is needed to accurately identify rNMB, and interventions are needed to reduce its burden and associated adverse outcomes.
在涉及使用神经肌肉阻滞剂（NMBA）的外科手术之后，神经肌肉阻滞（NMB）的完全逆转对于患者安全和预后很重要。随着NMB管理的进展，缺乏关于现实临床环境中残余神经肌肉阻滞（rNMB；不完全神经肌肉恢复）的流行病学及后果的已发表证据。因此，我们旨在使用系统评价框架来研究rNMB的负担及其相关的临床、经济和人文结局。
进行电子和会议数据库检索，纳入观察性研究，这些研究考察接受或未接受NMBA拮抗剂的接受手术的成人中的rNMB或相关结局。
在1438篇筛选的摘要中，纳入了58项研究，共25277例患者。各研究报告的rNMB定义不一致，分别有44项（76%）和29项（50%）研究使用定量和定性方法来检测rNMB。rNMB最常见的定义是在进入麻醉后护理单元（PACU）时四个成串刺激比值（TOFR）<0.9（29项研究）和TOFR<0.7（16项研究）。对于进入PACU时TOFR<0.9，总体rNMB发生率范围为0%至90.5%（中位数30%）；在舒更葡糖（SUG）组中为0%至16.0%；在新斯的明（NEO）组中为3.5%至90.5%；在自主恢复（SR）组中为15%至89%。21项研究报告了根据有无rNMB的临床结局（再次插管、轻度低氧血症或呼吸事件）或资源利用结局（住院/PACU住院时间[LOS]）。与无rNMB的患者相比，有rNMB的患者急性呼吸事件发生率更高。
现实世界的观察性研究显示rNMB负担沉重且伴有健康后遗症，尽管各研究报告的rNMB测量方法不一致。需要适当的定量测量来准确识别rNMB，并且需要采取干预措施以减轻其负担及相关不良结局。
