Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA.
Anaesthesiol Intensive Ther. 2021;53(4):325-328. doi: 10.5114/ait.2021.109398.
Neostigmine, an acetylcholinesterase inhibitor, is used to reverse the effects of non-depolarizing neuromuscular blocking agents. Inappropriate dosing of neostigmine can lead to post-operative respiratory complications. Post-operative respiratory complications are associated with major morbidity and mortality. The purpose of this case-control study was to determine neuromuscular blockade-related risk factors associated with post-operative respiratory complications (specifically, reintubation, respiratory insufficiency, hypoxia, and/or aspiration).
We performed an Institutional Review Board-approved case-control study of all patients who underwent a general anesthetic requiring neuromuscular blockade at Tufts Medical Center between March 22, 2013 and June 1, 2019. Cases were patients who experienced post-operative complications. We identified 58 controls and 116 cases from a database of 130,178 patients during the 74-month study period.
After adjusting for covariates, the administration of high dose neostigmine (> 60 mg per kg ideal body weight) was associated with increased odds of post-operative respiratory complications (odds ratio = 8.2; 95% CI: 2.5-26.6, P < 0.001). Rocuronium dose and the use of train-of-four peripheral nerve stimulator were not associated with post-operative respiratory complications.
High dose neostigmine was identified as an independent risk factor for post-operative respiratory complications. Our study suggests that inappropriate dosing of neostigmine continues to be a problem despite growing evidence of an association with respiratory complications.
新斯的明是一种乙酰胆碱酯酶抑制剂，用于逆转非去极化神经肌肉阻滞剂的作用。新斯的明剂量不当可导致术后呼吸并发症。术后呼吸并发症与严重发病率和死亡率相关。本病例对照研究的目的是确定与术后呼吸并发症（具体为重新插管、呼吸功能不全、缺氧和/或误吸）相关的神经肌肉阻滞相关危险因素。
我们对 2013 年 3 月 22 日至 2019 年 6 月 1 日期间在塔夫茨医疗中心接受全身麻醉并需要神经肌肉阻滞的所有患者进行了机构审查委员会批准的病例对照研究。病例为术后发生并发症的患者。在 74 个月的研究期间，我们从 130178 名患者的数据库中确定了 58 名对照和 116 名病例。
调整协变量后，大剂量新斯的明（> 60mg/kg 理想体重）给药与术后呼吸并发症的发生几率增加相关（比值比= 8.2；95%CI：2.5-26.6，P < 0.001）。罗库溴铵剂量和使用四周围神经刺激器与术后呼吸并发症无关。
大剂量新斯的明被确定为术后呼吸并发症的独立危险因素。我们的研究表明，尽管越来越多的证据表明与呼吸并发症有关，但新斯的明剂量不当仍然是一个问题。
