Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain.
Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.
Sci Rep. 2022 Sep 2;12(1):14955. doi: 10.1038/s41598-022-18917-y.
In recent years, some studies have generated controversy since they conclude that intraoperatively pharmacological reversal of neuromuscular blockade does not contribute to the reduction of postoperative residual neuromuscular blockade or pulmonary complications. Therefore, the main objective of this study was to assess the incidence of residual neuromuscular blockade and postoperative pulmonary complications according to spontaneous or pharmacological neuromuscular reversal. The secondary aim was to present a prognostic model to predict the probability of having postoperative residual neuromuscular blockade depending on a patient's comorbidities and intraoperative neuromuscular blocking agents management. A single-center, prospective, observational cohort study including patients undergoing surgical procedures with general anesthesia was designed. A total of 714 patients were analyzed. Patients were divided into four groups: cisatracurium with spontaneous reversal, cisatracurium with neostigmine antagonism, rocuronium with spontaneous reversal, and rocuronium with sugammadex antagonism. According to our binomial generalized linear model, none of the studied comorbidities was a predisposing factor for an increase in the residual neuromuscular blockade. However, in our study, pharmacological reversal of rocuronium with sugammadex and, particularly, neuromuscular monitoring during surgery were the factors that most effectively reduced the risk of residual neuromuscular blockade as well as early and late postoperative pulmonary complications.
近年来，一些研究引发了争议，因为它们的结论是术中应用药理学方法逆转神经肌肉阻滞并不能减少术后残余神经肌肉阻滞或肺部并发症。因此，本研究的主要目的是评估根据自主或药理学神经肌肉逆转来评估残余神经肌肉阻滞和术后肺部并发症的发生率。次要目的是提出一个预测模型，根据患者的合并症和术中神经肌肉阻滞剂管理来预测术后残余神经肌肉阻滞的可能性。本研究为单中心、前瞻性、观察性队列研究，纳入了接受全身麻醉下手术的患者。共分析了 714 例患者。患者分为四组：顺式阿曲库铵自主逆转组、顺式阿曲库铵新斯的明拮抗组、罗库溴铵自主逆转组和罗库溴铵琥珀胆碱拮抗组。根据我们的二项式广义线性模型，没有一种研究的合并症是增加残余神经肌肉阻滞的危险因素。然而，在我们的研究中，罗库溴铵琥珀胆碱的药理学逆转，特别是手术期间的神经肌肉监测，是最有效地降低残余神经肌肉阻滞以及早期和晚期术后肺部并发症风险的因素。
