Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Br J Anaesth. 2023 Jan;130(1):e148-e159. doi: 10.1016/j.bja.2022.04.023. Epub 2022 Jun 9.
Postoperative pulmonary complications are a source of morbidity after major surgery. In patients at increased risk of postoperative pulmonary complications we sought to assess the association between neuromuscular blocking agent reversal agent and development of postoperative pulmonary complications.
We conducted a retrospective matched cohort study, a secondary analysis of data collected in the prior STRONGER study. Data were obtained from the Multicenter Perioperative Outcomes Group. Included patients were aged 18 yr and older undergoing non-emergency surgery under general anaesthesia with tracheal intubation with neuromuscular block and reversal, who were predicted to be at elevated risk of postoperative pulmonary complications. This risk was defined as American Society of Anesthesiologists Physical Status 3 or 4 in patients undergoing either intrathoracic or intra-abdominal surgery who were either aged >80 yr or underwent a procedure lasting >2 h. Cohorts were defined by reversal with neostigmine or sugammadex. The primary composite outcome was the occurrence of pneumonia or respiratory failure.
After matching by institution, sex, age (within 5 yr), body mass index, anatomic region of surgery, comorbidities, and neuromuscular blocking agent, 3817 matched pairs remained. The primary postoperative pulmonary complications outcome occurred in 224 neostigmine cases vs 100 sugammadex cases (5.9% vs 2.6%, odds ratio 0.41, P<0.01). After adjustment for unbalanced covariates, the adjusted odds ratio for the association between sugammadex use and the primary outcome was 0.39 (P<0.0001).
In a cohort of patients at increased risk for pulmonary complications compared with neostigmine, use of sugammadex was independently associated with reduced risk of subsequent development of pneumonia or respiratory failure.
术后肺部并发症是大手术后发病率的一个来源。在术后肺部并发症风险增加的患者中，我们试图评估神经肌肉阻滞剂拮抗剂与术后肺部并发症发展之间的关系。
我们进行了一项回顾性匹配队列研究，这是先前 STRONGER 研究数据的二次分析。数据来自多中心围手术期结局组。纳入的患者年龄在 18 岁及以上，在全身麻醉下接受非紧急手术，气管插管并使用神经肌肉阻滞剂，预计术后肺部并发症风险增加。这种风险定义为接受胸内或腹内手术的美国麻醉医师协会身体状况 3 或 4 级的患者，年龄>80 岁或手术持续时间>2 小时。队列由新斯的明或琥珀酰明胶逆转定义。主要复合结局是肺炎或呼吸衰竭的发生。
通过机构、性别、年龄（5 年内）、体重指数、手术解剖区域、合并症和神经肌肉阻滞剂匹配后，仍有 3817 对匹配。新斯的明组 224 例发生主要术后肺部并发症，琥珀酰明胶组 100 例（5.9%比 2.6%，比值比 0.41，P<0.01）。在调整不平衡协变量后，琥珀酰明胶使用与主要结局之间关联的调整比值比为 0.39（P<0.0001）。
与新斯的明相比，在一组肺部并发症风险增加的患者中，使用琥珀酰明胶与随后发生肺炎或呼吸衰竭的风险降低独立相关。
