Li Gen, Freundlich Robert E, Gupta Rajnish K, Hayhurst Christina J, Le Chi H, Martin Barbara J, Shotwell Matthew S, Wanderer Jonathan P
Anesthesiology. 2021 Jun 1;134(6):862-873. doi: 10.1097/ALN.0000000000003735.
Postoperative residual neuromuscular blockade related to nondepolarizing neuromuscular blocking agents may be associated with pulmonary complications. In this study, the authors sought to determine whether sugammadex was associated with a lower risk of postoperative pulmonary complications in comparison with neostigmine.
Adult patients from the Vanderbilt University Medical Center National Surgical Quality Improvement Program database who underwent general anesthesia procedures between January 2010 and July 2019 were included in an observational cohort study. In early 2017, a wholesale switch from neostigmine to sugammadex occurred at Vanderbilt University Medical Center. The authors therefore identified all patients receiving nondepolarizing neuromuscular blockades and reversal with neostigmine or sugammadex. An inverse probability of treatment weighting propensity score analysis approach was applied to control for measured confounding. The primary outcome was postoperative pulmonary complications, determined by retrospective chart review and defined as the composite of the three postoperative respiratory occurrences: pneumonia, prolonged mechanical ventilation, and unplanned intubation.
Of 10,491 eligible cases, 7,800 patients received neostigmine, and 2,691 received sugammadex. A total of 575 (5.5%) patients experienced postoperative pulmonary complications (5.9% neostigmine vs. 4.2% sugammadex). Specifically, 306 (2.9%) patients had pneumonia (3.2% vs. 2.1%), 113 (1.1%) prolonged mechanical ventilation (1.1% vs. 1.1%), and 156 (1.5%) unplanned intubation (1.6% vs. 1.0%). After propensity score adjustment, the authors found a lower absolute incidence rate of postoperative pulmonary complications over time (adjusted odds ratio, 0.91 [per year]; 95% CI, 0.87 to 0.96; P < .001). No difference was observed on the odds of postoperative pulmonary complications in patients receiving sugammadex in comparison with neostigmine (adjusted odds ratio, 0.89; 95% CI, 0.65 to 1.22; P = 0.468).
Among 10,491 patients at a single academic tertiary care center, the authors found that switching neuromuscular blockade reversal agents was not associated with the occurrence of postoperative pulmonary complications.
与非去极化神经肌肉阻滞剂相关的术后残余神经肌肉阻滞可能与肺部并发症有关。在本研究中，作者试图确定与新斯的明相比，舒更葡糖是否与较低的术后肺部并发症风险相关。
纳入范德比尔特大学医学中心国家外科质量改进计划数据库中2010年1月至2019年7月期间接受全身麻醉手术的成年患者，进行一项观察性队列研究。2017年初，范德比尔特大学医学中心全面从新斯的明改用舒更葡糖。因此，作者确定了所有接受非去极化神经肌肉阻滞并使用新斯的明或舒更葡糖进行逆转的患者。采用治疗权重倾向评分分析的逆概率方法来控制测量到的混杂因素。主要结局是术后肺部并发症，通过回顾病历确定，定义为术后三种呼吸事件的综合：肺炎、机械通气时间延长和意外插管。
在10491例符合条件的病例中，7800例患者接受了新斯的明，2691例接受了舒更葡糖。共有575例（5.5%）患者发生术后肺部并发症（新斯的明组为5.9%，舒更葡糖组为4.2%）。具体而言，306例（2.9%）患者发生肺炎（3.2%对2.1%），113例（1.1%）机械通气时间延长（1.1%对1.1%），156例（1.5%）意外插管（1.6%对1.0%）。经过倾向评分调整后，作者发现随着时间推移，术后肺部并发症的绝对发生率较低（调整后的优势比为0.91[每年]；95%置信区间为0.87至0.96；P<.001）。与新斯的明相比，接受舒更葡糖的患者术后发生肺部并发症的几率没有差异（调整后的优势比为0.89；95%置信区间为0.65至1.22；P = 0.468）。
在单一学术三级医疗中心的10491例患者中，作者发现更换神经肌肉阻滞逆转剂与术后肺部并发症的发生无关。
